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Cervix-Cytology

Atypia / premalignant / preinvasive lesions

Atypical glandular cells (AGC)


Reviewer: Marilin Rosa, M.D., University of Florida (see Reviewers page)
Revised: 5 March 2011, last major update March 2011
Copyright: (c) 2006-2011, PathologyOutlines.com, Inc.

Definition
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● Bethesda system 2001 uses terminology AGC - Atypical glandular cells; "atypical glandular cells of undetermined significance (AGUS)" is no longer used
● Frequently associated with a clinically significant diagnosis (9-45%, Int J Gynaecol Obstet 2005;91:238, Obstet Gynecol 2005;105:494, Am J Clin Path 2004;122:575), including squamous dysplasia (Obstet Gynecol 1992;79:101)
● CIN lesions (squamous dysplasia) have been found in 8% (J Obstet Gynaecol Res 2010 Dec 15 [Epub ahead of print]) to 83% of women with AGC, of which 40% to 68% are CIN 2/3 (moderate/severe, Gynecol Oncol 2007;104:366)
● HPV DNA testing at time of colposcopy is preferred in women with atypical endocervical, endometrial, or glandular cells NOS, if not already obtained (J Low Genit Tract Dis 2007;11:201, Diagn Cytopathol 2006;34:235)
● HPV testing has excellent negative predictive value for the absence of SIL (Am J Obstet Gynecol 2005;193:559)

Terminology
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This category is subdivided as follows:

Atypical
● Endocervical cells, (NOS or specify in comments)
● Endometrial cells, (NOS or specify in comments)
● Glandular cells, (NOS or specify in comments)

Atypical
● Endocervical cells, favor neoplastic
● Glandular cells, favor neoplastic

Treatment
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● Colposcopy with endocervical sampling is recommended for all subcategories of AGC and AIS (adenocarcinoma in situ)
● Endometrial sampling is recommended in conjunction with colposcopy and endocervical sampling in women 35 years and older with all subcategories of AGC and AIS, and for women under 35 with clinical risk of endometrial pathology (J Low Genit Tract Dis 2007;11:201)
● The use of HPV DNA testing or repeat cervical cytology alone is unacceptable for the initial management of all subcategories of AGC and AIS

Cytology description
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● Morphological changes of glandular cells which are too pronounced for inflammatory or reactive origin, but insufficient to diagnose adenocarcinoma
● More likely to be neoplastic if decreased cytoplasm, irregular nuclear membranes, nuclear hyperchromasia and nucleoli present (Cytopathology 2005;16:295)

Cytology images
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Various images

End of Cervix-cytology > Atypia / premalignant / preinvasive lesions > Atypical glandular cells (AGC)


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