Histopathological challenges in assessing invasion in squamous, glandular neoplasia of the cervix

Correlation between invasive pattern and immunophenotypic alterations in endocervical adenocarcinoma

“…The immunophenotypic changes were associated with a morphological alteration in the neoplastic epithelium, particularly in the infiltrative glands, that included loss of cellular polarity, nuclear enlargement and more abundant eosinophilic cytoplasm. These features are well‐recognized diagnostic indicators of superficial/early stromal invasion in cervical neoplasia of both squamous and glandular types, 10 but in our experience they frequently also occur at the margin of more deeply invasive tumour elements. In some tumours the infiltrative‐pattern type immunophenotypic changes also occurred within the attenuated epithelium lining dilated segments of otherwise conventional tumour glands, a morphological feature that has been described previously as an indicator of invasion in endocervical neoplasia 10 .…”

“…These features are well‐recognized diagnostic indicators of superficial/early stromal invasion in cervical neoplasia of both squamous and glandular types, 10 but in our experience they frequently also occur at the margin of more deeply invasive tumour elements. In some tumours the infiltrative‐pattern type immunophenotypic changes also occurred within the attenuated epithelium lining dilated segments of otherwise conventional tumour glands, a morphological feature that has been described previously as an indicator of invasion in endocervical neoplasia 10 . Interestingly, such glandular dilatation is reminiscent of the ‘glandular pores’ observed at the invasive front in colorectal neoplasia, 26 and of the microcystic changes occurring as part of microcystic, elongated and fragmented (MELF) pattern invasion in endometrial adenocarcinoma; 27,28 the latter process has been shown to show immunophenotypic features consistent with EMT 29,30 …”

“…Generally this histological pattern is more easily recognized to be invasive, but the changes can be subtle in superficial tumours where only inconspicuous discontinuous glands within the stroma or nests of cells budding from foci of ACIS may be present 6–8 . A helpful diagnostic clue to the presence of early invasion is a cytological alteration in which the invasive neoplastic cells show nuclear enlargement, nucleolation and increased eosinophilic cytoplasm compared to the adjacent in situ elements 9,10 . Similar morphological changes also occur in superficially invasive squamous carcinomas.…”

Issues of the Evaluation of Endocervical Cells of the Uterine Cervix on Cytological Smears

“…Abnormalities of the endocervical epithelium mentioned by a number of authors [5][6][7] are not quite suitable material with respect to the evaluation in the form of a PAP test. The sampling origin is the transformation (transitional) zone where is located glandular and squamous epithelium.…”

“…Another significant step towards a proper diagnosis is cytohistological correlation and the examination of demanding preparations under 400-1000x magnification [7][8][9].…”