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Cervix-Cytology

Atypia / premalignant / preinvasive lesions

Adenocarcinoma in situ (AIS)


Reviewer: Marilin Rosa, M.D., University of Florida (see Reviewers page)
Revised: 24 June 2011, last major update June 2011
Copyright: (c) 2006-2011, PathologyOutlines.com, Inc.

General
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● Predominantly a screening-detected disease (Acta Cytol 2004;48:595)
● False negatives are common, particularly for endometrioid AIS or AIS cells resembling reactive endocervical cells (Am J Clin Pathol 1997;107:30, Am J Clin Pathol 1998;109:738)
● False negatives also due to minimal, poorly preserved abnormal material, overly conservative approach in assessing unusual large sheets or aggregates of glandular cells (Cancer 2004;102:280), and inherent difficulty in detection (Arch Pathol Lab Med 2004;128:153)

Etiology
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● HPV infection is necessary for development of AIS

Clinical features
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● Generally asymptomatic

Treatment
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● Colposcopy with endocervical sampling is recommended for women with AIS
● Endometrial sampling is recommended in conjunction with colposcopy and endocervical sampling in women 35 years and older (J Low Genit Tract Dis 2007;11:201)
● Cold-knife conization is recommended to preserve specimen orientation and permit optimal interpretation of histology and margin status
● LEEP is not recommended due to its association with positive margins (Gynecol Oncol 2002;86:361)

Cytology description
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● Tightly crowded sheets of abnormal glandular cells with architectural disarray, often with short strips of pseudostratified columnar cells near edges
● Nuclei may be partially denuded, causing a feathered appearance; nuclei are enlarged, usually oval and hyperchromatic
● Often prominent nucleoli
● No tumor diathesis
● For endometrioid AIS, most useful criteria for diagnosis are predominance of groups with marked crowding, focal feathering, nuclear hyperchromatism with coarsening of chromatin and occasional mitotic figures
● Features favoring a benign diagnosis are sheets of cells, endometrial tubules and endometrial stroma

Cytology images
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ThinPrep images

           
Various images

Positive stains
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● p16 can be use to discriminate endocervical adenocarcinomas from benign lesions and from endometrioid adenocarcinomas of the uterine corpus (Virchows Arch 2006;448:597)

End of Cervix-cytology > Atypia / premalignant / preinvasive lesions > Adenocarcinoma in situ (AIS)


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