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Abstract

ObjectiveHyperchromatic crowded groups (HCG), a term first introduced into the cytology literature by DeMay in 1995, are commonly observed in Pap tests and may rarely be associated with serious but difficult to interpret lesions. In this study, we specifically defined HCG as dark crowded cell groups with more than 15 cells which can be identified at 10× screening magnification.MethodsWe evaluated consecutive liquid-based (Surepath) Pap tests from 601 women (age 17–74 years, mean age 29.4 yrs) and observed HCG in 477 cases. In all 477 HCG cases, Pap tests were found to be satisfactory and to contain an endocervical sample. HCG were easily detectible at 10× screening magnification (size up to 400 um, mean 239.5 um) and ranged from 1 to 50 (mean 19.5) per Pap slide.ResultsHCG predominantly represented 3-Dimensional groups of endocervical cells with some nuclear overlap (379/477 – 79%), reactive endocervical cells with relatively prominent nucleoli and some nuclear crowding (29/477 – 6%), clusters of inflammatory cells (25/477 – 5.2%), parabasal cells (22/477 – 4.6%), endometrial cells (1/477 – 0.2%). Epithelial cell abnormalities (ECA) were present in only 21 of 477 cases (4.6%). 18 of 21 women with HCG-associated ECA were less than 40 years old; only 3 were =/> 40 years. HCG-associated final abnormal Pap test interpretations were as follows: ASCUS (6/21 – 28%), LSIL (12/21 – 57%), ASC-H (2/21 – 9.5%), and HSIL/CIN2-3 (3/21 – 14%). The association of HCG with ECA was statistically significant (p = 0.0174. chi-square test). In patients with ECA, biopsy results were available in 10 cases, and 4 cases of biopsy-proven CIN2/3 were detected. Among these four cases, HCG in the Pap tests, in retrospect represented the lesional high grade cells in three cases (one HSIL case and two ASC-H cases). Interestingly, none of the 124 cases without HCG were found to have an epithelial cell abnormality.ConclusionWe conclude: a. HCG are observed in a high proportion of cervical smears. b. In the vast majority of cases, HCG are benign. c. ECA were only observed in cases with HCG. This observation is consistent with the hypothesis that the presence of HCG in Pap tests most often represents adequate sampling of the transformation zone, thus increasing the chances of detecting an epithelial cell abnormality. d. Only a few cases with HCG were associated with a serious ECA, but careful scrutiny of all HCG appears warranted to avoid the potential diagnostic pitfall of a significant false negative interpretation.

p16^INK4a and ProEx C Immunostains Facilitate Differential Diagnosis of Hyperchromatic Crowded Groups in Liquid-Based Papanicolaou Tests with Menstrual Contamination

“…Previous studies have shown that the vast majority of these HCGs are benign and include 3-dimensional endocervical cells, reactive endocervical cells, endometrial cells, tubal metaplasia, parabasal cells in atrophy, and inflammatory cells [1,18,19]. However, HCGs may also represent precancerous or malignant lesions and the difficulty in cytologic interpretation may cause a significant diagnostic pitfall.…”

“…HCGs are frequently encountered in liquid-based cervical cytology and can be seen in as many as 79% of Pap specimens [1]. Previous studies have shown that the vast majority of these HCGs are benign and include 3-dimensional endocervical cells, reactive endocervical cells, endometrial cells, tubal metaplasia, parabasal cells in atrophy, and inflammatory cells [1,18,19].…”

“…One of the common challenges is to determine the nature of hyperchromatic crowded groups (HCGs) in cervicovaginal specimens. Although most of the HCGs represent benign lesions, such as parabasal cells, reactive endocervical cells, tubal metaplasia or benign endometrial cells, a small portion of HCGs are precancerous or malignant [1]. The distinction becomes even more difficult if specimens are collected during menstruation, when numerous clusters of endometrial cells, i.e.…”

Hyperchromatic-crowded groups (HCG) in pap smears

“…[ 1 ] The glandular spectrum of HCG from MGH may also display mild cytologic atypia with nuclear enlargement and hyperchromasia. [ 2 ] The cells may have multiple nucleoli, mitotic figures, and apoptotic bodies (normoblast- like apoptosis in squamous metaplastic cells). [ 1 , 2 ] AIS (option B), which is typically asymptomatic, demonstrates a different cytologic spectrum.…”

“…[ 2 ] The cells may have multiple nucleoli, mitotic figures, and apoptotic bodies (normoblast- like apoptosis in squamous metaplastic cells). [ 1 , 2 ] AIS (option B), which is typically asymptomatic, demonstrates a different cytologic spectrum. AIS displays crowded sheets of stratified and enlarged cigar-shaped glandular cells with hyperchromatic nuclei with coarse chromatin, relatively inconspicuous nucleoli, mitoses, particularly in an apical location, and apoptotic bodies.…”