Although it has long been known that microglandular hyperplasia (MGH) may be associated with cytologic atypia in cervical smears, the cytomorphology of MGH has not been described in great detail. To clarify its cytomorphology, Pap smears obtained from biopsy proven cases of MGH over a 3-yr period were reviewed. Of 122 smears containing endocervical cells, 34 (28%) showed striking glandular abnormalities. In two cases, adenocarcinoma and adenocarcinoma in situ were falsely suggested and a high grade squamous intraepithelial lesion (HGSIL-CIN III) was not confirmed in a conization specimen which showed only low grade SIL and MGH. Review of six cytologic diagnoses of HGSIL (CIN III) unconfirmed on biopsy suggested overcalls related to MGH related atypia in five. Cytologic features of MGH, therefore, may occasionally result in erroneous interpretations of HGSIL as well as glandular neoplasia. Although these changes may be striking, comparison with glandular atypia not associated with MGH shows that they are not entirely specific.

Analysis of 1,000 cases of fine-needle aspiration biopsies of subcutaneous lesions revealed 430 cases diagnosed as malignant. Squamous cell carcinoma represented 37% of the malignant neoplasms, and many of these cases were highly differentiated tumors. Although the presence of keratinized squamous cells in superficial aspirates is strongly suggestive of squamous cell carcinoma, other lesions may produce atypical squamous cells on aspiration biopsy and should be considered in the differential diagnosis. These include acanthotic ameloblastomas, metaplastic adenocarcinomas and Warthin's tumors, branchial cleft cysts, odontogenic keratocysts, and epidermal inclusion cysts. Two-needle aspirates from these cases were incorrectly interpreted as squamous cell carcinoma. The cytologic and some of the histologic characteristics of these lesions that may pose a diagnostic problem are presented. Careful evaluation of nuclear and cytoplasmic features, cellular background, clinical findings, and history is essential to avoid a false positive diagnosis of squamous cell carcinoma.

BACKGROUND Hormonal effects have always played a significant role in gynecologic cytology. In atrophic and postpartum smears, interpretation may be complicated by large numbers of parabasal cells with high nuclear cytoplasmic ratios and hyperchromatic nuclei that mimic precancerous lesions (squamous intraepithelial lesions, SILs). The authors have observed atrophic and postpartumlike changes in patients receiving depot‐medroxyprogesterone acetate for prolonged periods. These alterations may lead to diagnostic uncertainty or falsely suggest the presence of SIL. METHODS To evaluate the effect of chronic hormone use, smears from 29 depot‐medroxyprogesterone acetate users (average age, 35.9 years) who had been amenorrheic for 5‐72 months (average, 22.6 months) were identified. This group was matched with 25 nonusers (average age, 31.9 years). Maturation values (MVs) were calculated for both groups and cellular findings were evaluated. RESULTS The user group had a significantly lower MV (38.45 vs. 64.60, P < 0.001). Among users, 6 of 29 smears (21%) were abnormal. One low grade SIL was biopsy‐confirmed, but two high grade SILs and three smears of ASCUS had a negative Papanicolaou (Pap) smear and/or biopsy follow‐up. Among nonusers, 4 of 25 smears (16%) were abnormal. Two patients with high grade SIL smears had positive biopsy or Pap smear follow‐up, one with an ASCUS smear had a negative Pap smear follow‐up, and one with a low grade SIL was lost to follow‐up. CONCLUSIONS The immature cellular pattern seen in smears from long term depot‐medroxyprogesterone acetate users led to difficulty in determining the diagnosis in some cases. ASCUS cases among users were associated with high nuclear cytoplasmic ratios and hyperchromasia in parabasal metaplasialike cells. Biopsies in these cases showed epithelial atrophy, which was often associated with acute inflammation. In view of the fact that long term depot‐medroxyprogesterone acetate administration may induce changes that mimic high grade SIL in a population already at high risk for SIL, there may be problematic cases in which diagnostic uncertainty is inevitable. Cancer (Cancer Cytopathol) 1998;84:328‐334. © 1998 American Cancer Society.

To examine the influence of sample cellularity and the presence of endocervical columnar cells on the detection of cervical dysplasia, Papanicolaou (Pap) smears taken from patients with biopsy-proven CIN II and III were analyzed retrospectively. Adequacy was semiquantitated by dividing each smear into 15 equal areas using a lined template and assigning an adequacy index (AI) of 0 to 15. The total false-negative (FN) rate was 15.8 percent, with 6.1% representing interpretive error and 9.7% representing sampling error. For FN slides truly lacking abnormal cells, the average AI was significantly lower than that of true positives (TP), even when endocervical columnar cells were present. The entire group was then blindly re-evaluated using a subjective application of the Bethesda System, classifying slides as satisfactory, less than optimal, and unsatisfactory. Although correlation of AI with the rapid Bethesda System categorization was imperfect, the exclusion of less than optimal and unsatisfactory smears also lowered the FN rate, but less effectively. An AI scoring technique, therefore, may be useful in the routine evaluation of Pap smear adequacy.

Cel lular morphology may be altered by a variety of iatrogenic factors. These changes may render cytologic diagnosis more difficult and may increase the chance of both false-positive and false-negative interpretations. The authors review a range of physician-related changes involving specimen acquisition, instrumentation, radiation and chemotherapy, ablative procedures, and surgical revisions of anatomic structures in gynecologic and nongynecologic cytology.