Cytologic atypia associated with microglandular hyperplasia

Abstract

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.

Microglandular endocervical hyperplasia and tubal metaplasia: Pitfalls in the diagnosis of adenocarcinoma on cervical smears

“…In a recent study, Valente et al 4 reviewed 188 cervicovaginal smears obtained from biopsy-proven cases of MEH. Of the 188 smears, 122 contained endocervical cells.…”

“…3,4,8 The lesion typically occurs in young women (mean age, 33.5 yr), and it is frequently associated with oral contraceptive use and less commonly with pregnancy. The patients are usually asymptomatic but may complain of abnormal vaginal bleeding or vaginal discharge.…”

“…Recently, the cytologic features of microglandular endocervical hyperplasia 3,4 and tubal metaplasia [5][6][7] were described on cervical smear specimens. Since diagnostic pitfalls exist on histologic material from these lesions, 8,9 the purpose of this study was to determine if microglandular endocervical hyperplasia (MEH) and tubal metaplasia (TM) can be reliably distinguished from AIS and/or invasive adenocarcinoma on cervical smears.…”

Microglandular Hyperplasia of the Uterine Cervix

“…In our experience with hysterectomies, MGH is present in 30% of women under 40 years of age and 15% in those older than 40. Most authors agree that MGH is the cause of false positive findings in cervical cytology because of the presence of endocervical glandular cells with marked cytologic atypia that can be confused with adenocarcinoma in situ and endocervical adenocarcinoma and are also responsible for the diagnosis of atypical glandular cells of undetermined significance (AGUS) 1,5,6,8,10 Until now no specific cytologic parameters have been described for MGH. The aim of this study was to identify cytomorphologic features specific to MGH and to evaluate the presence of cytologic atypia, false positive diagnoses and AGUS.…”

Significance of AGUS Pap Smears in Pregnant and Postpartum Women

“…In a rare situation, such as microglandular hyperplasia, the glandular atypia can be striking and may mimic a preneoplastic or neoplastic process. 1,38,39 One of our cases displayed rare hyperchromatic, crowded groups along with mild to moderate nuclear atypia, leading to a diagnosis of AGUS. Follow-up revealed microglandular hyperplasia.…”