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The The Hyperchromatic Hyperchromatic Crowded Crowded Groups Groups - - Cytologic Cytologic Diagnosis of Diagnosis of Glandular Lesions Glandular Lesions Paul K. Shitabata, M.D. Paul K. Shitabata, M.D. APMG APMG

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Page 1: The Hyperchromatic Crowded Groups-Cytologic Diagnosis of

The The HyperchromaticHyperchromatic Crowded Crowded GroupsGroups--CytologicCytologic Diagnosis of Diagnosis of

Glandular LesionsGlandular Lesions

Paul K. Shitabata, M.D.Paul K. Shitabata, M.D.APMGAPMG

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IntroductionIntroduction

1515--25% of cervical carcinomas are 25% of cervical carcinomas are adenocarcinomasadenocarcinomasAISAIS--Pap smears 55 Pap smears 55 -- 70% sensitivity 70% sensitivity AGUS 0.13 AGUS 0.13 -- 0.46% of 0.46% of papspapsTrue glandular precursors or True glandular precursors or adenocarcinomaadenocarcinoma present in only .01 to present in only .01 to .015%.015%

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Glandular lesionsGlandular lesions

Non Non neoplasticneoplasticTubalTubal MetaplasiaMetaplasiaExfoliated lower segment Exfoliated lower segment endometruimendometruimMenstrual endometrial CellsMenstrual endometrial CellsReactive Reactive endocervicalendocervical cellscellsMicroglandularMicroglandular hyperplasiahyperplasiaOtherOther

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Glandular lesions in Pap SmearsGlandular lesions in Pap Smears

NeoplasticNeoplasticAISAISInvasive Invasive adenocarcinomaadenocarcinomaHSIL with HSIL with endocervicalendocervical glandular extensionglandular extensionEndometrial carcinomaEndometrial carcinomaSquamousSquamous CarcinomaCarcinoma

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AdenocarcinomaAdenocarcinoma in situ (AIS)in situ (AIS)

3737--41 yrs for AIS41 yrs for AIS4444--54 yrs for 54 yrs for AdenocarcinomaAdenocarcinomaHPV16 and 18HPV16 and 18Skip areas commonSkip areas commonAIS associated with SIL in 30 AIS associated with SIL in 30 -- 60% of 60% of casescases

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AISAISGROUPS GROUPS -- Crowded, Crowded, hyperchromatichyperchromatic

Glandular differentiation Glandular differentiation Pale, foamy or vacuolated cytoplasmPale, foamy or vacuolated cytoplasmStratification and crowdingStratification and crowdingRosettes and glandsRosettes and glandsSyncytiaSyncytia with “ feathering”with “ feathering”

No diathesisNo diathesis

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AISAIS

NUCLEINUCLEIHigh N/C RatioHigh N/C RatioOval to elongated or irregular, moldingOval to elongated or irregular, moldingMarked Marked hyperchromasiahyperchromasiaCoarse chromatinCoarse chromatinApoptotic bodies (70%)Apoptotic bodies (70%)Mitotic figures in 40 Mitotic figures in 40 -- 60% of cases60% of cases

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Invasive Invasive AdenocarcinomaAdenocarcinoma of of CervixCervix

Less nuclear crowding, abnormal glandular Less nuclear crowding, abnormal glandular arrangements and abundancearrangements and abundanceMore cytoplasm, larger nuclei, more More cytoplasm, larger nuclei, more irregular, vesicular chromatin or coarse irregular, vesicular chromatin or coarse and prominent nucleoliand prominent nucleoliDiathesisDiathesis

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False NegativeFalse Negative

Small “ Small “ endometroidendometroid “ AIS“ AISMistaken for menstrual or LUSMistaken for menstrual or LUSClean backgroundClean backgroundTight groups with extreme crowdingTight groups with extreme crowdingCoarse nucleiCoarse nucleiFeathering, rosettes, columnar shapesFeathering, rosettes, columnar shapesAbsence of endometrial tubules, sheets or Absence of endometrial tubules, sheets or stromastroma

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False NegativeFalse Negative

AIS or AIS or AdenocarcinomaAdenocarcinoma mimicking reactive mimicking reactive endocervicalendocervical cellscells

Uniform population (not a spectrum)Uniform population (not a spectrum)Crowding, nuclear enlargement, increased Crowding, nuclear enlargement, increased N/C ratioN/C ratioCoarse chromatinCoarse chromatinSmall to prominent nucleoli in every cellSmall to prominent nucleoli in every cell

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Case 1Case 1

37 year old 37 year old pap smear pap smear -- AGUS, r/o IUDAGUS, r/o IUD

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IUDIUD

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IUDIUD

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IUDIUD

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IUD ChangesIUD Changes

DDX DDX adenocarcinomaadenocarcinoma -- lack of malignant lack of malignant featuresfeaturesDDX DDX CISCIS -- actinomycesactinomyces

few atypical cellsfew atypical cellsBland dark chromatinBland dark chromatinNo nucleoli No nucleoli No No multinucleationmultinucleation

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Case 2Case 2

68 year old68 year oldPap smear Pap smear -- AGUS r/o AGUS r/o adenoadeno

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Reactive Glandular CellsReactive Glandular Cells

Spectrum of Spectrum of atypiaatypiaFine or smudged chromatin Fine or smudged chromatin Smooth nuclear membranesSmooth nuclear membranesProminent to absent nucleoliProminent to absent nucleoliLow N/C ratioLow N/C ratioMinimal overlap “ lay flat”Minimal overlap “ lay flat”Often associated with SILOften associated with SIL

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Case 3Case 3

IndecIndec, C, 32 year old, C, 32 year oldPap smear Pap smear -- AGUSAGUS

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TubalTubal MetaplasiaMetaplasia

DDX: DDX: AdenocarcinomaAdenocarcinomaNuclei less crowdedNuclei less crowdedFiner chromatin patternFiner chromatin patternCiliaCiliaClear Clear cytoplasmiccytoplasmic vacuolesvacuoles

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Case 4Case 4

58 year old 58 year old Pap smear Pap smear -- Atypical repairAtypical repair

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Atypical repairAtypical repair

SheetSheet-- like arrangement “school of fish”like arrangement “school of fish”Finely granular chromatinFinely granular chromatinProminent nucleoliProminent nucleoliCyanophilicCyanophilic vacuolated cytoplasmvacuolated cytoplasmBiBi-- and and multinucleationmultinucleationMitosisMitosisSmall study (Small study (RimmRimm) ) -- 25% of SIL (LSIL)25% of SIL (LSIL)

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Case 5Case 5

29 year old29 year oldPap smear Pap smear -- AGUS, favor AGUS, favor

neoplasticneoplastic

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AdenocarcinomaAdenocarcinoma in situ/in situ/High Grade High Grade SquamousSquamousIntraepithelial LesionIntraepithelial Lesion

NeoplasticNeoplastic endocervicalendocervical cellscellsTall columnar cells with Tall columnar cells with hyperchromatichyperchromatic nuclei, coarse nuclei, coarse chromatin, feathery edges, rosetteschromatin, feathery edges, rosettesUniform population (not a spectrum)Uniform population (not a spectrum)Crowding, nuclear enlargement, increased N/C ratioCrowding, nuclear enlargement, increased N/C ratioCoarse chromatinCoarse chromatinSmall to prominent nucleoli in every cellSmall to prominent nucleoli in every cellNo diathesisNo diathesis

SquamousSquamous cells with increased N/C ratio, cells with increased N/C ratio, arranged in clusters but no rosettes or feathery arranged in clusters but no rosettes or feathery edgesedges

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Case 6Case 6

62 year old62 year oldPap smear Pap smear -- AdenocarcinomaAdenocarcinoma

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Endometrial Papillary Serous Endometrial Papillary Serous AdenocarcinomaAdenocarcinoma

Numerous papillary groups Numerous papillary groups Occasional Occasional psammomapsammoma bodiesbodiesHigh grade nuclei with prominent nucleoliHigh grade nuclei with prominent nucleoli

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Case 7Case 7

56 year old56 year oldPapsmearPapsmear-- PsammomaPsammoma bodiesbodies

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Endometrial Endometrial AdenocarcinomaAdenocarcinoma

CellularityCellularity -- lesslessCells Cells -- small,round, plump,degeneratedsmall,round, plump,degeneratedGroups Groups -- balls, molded groupsballs, molded groupsCytoplasm Cytoplasm -- Vacuolated, basophilic, often Vacuolated, basophilic, often with with PMNsPMNsNuclei Nuclei -- small, < 2.5x intermediate cell, small, < 2.5x intermediate cell, less less hyperchromatichyperchromatic with single nucleoluswith single nucleolusPsammomaPsammoma bodiesbodies--Ovarian>endometrialOvarian>endometrial

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Pap Smear Pap Smear PsammomaPsammoma BodiesBodies

Overall rare find in 1/30,000 Pap smearsOverall rare find in 1/30,000 Pap smearsBenignBenign

IUDIUDOvarian inclusion cystsOvarian inclusion cystsEndometritisEndometritis, tuberculosis, tuberculosisEndosalpingiosisEndosalpingiosisBirth control pillsBirth control pills

MalignantMalignantOvarian, endometrial, cervical , Ovarian, endometrial, cervical , endocervicalendocervicalneuroendocrineneuroendocrine carcinoma, fallopian tube, metastasiscarcinoma, fallopian tube, metastasis

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Case 8Case 8

34 year old 34 year old Pap smear Pap smear -- ASCUSASCUS

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High Grade High Grade SquamousSquamousIntraepithelial LesionIntraepithelial Lesion

DDX: Immature DDX: Immature squamoussquamous metaplasiametaplasiaSome types of HSIL exfoliate as small cells Some types of HSIL exfoliate as small cells -- d/d d/d histiocyteshistiocytes or or squamoussquamous metaplasiametaplasiaUncertaintyUncertainty

Wilbur Wilbur et alet al -- atypical immature atypical immature metaplasiametaplasia in 11/17 in 11/17 negative negative papspaps with subsequent HSILwith subsequent HSILSherman Sherman -- 20 20 negneg papspaps with retro review 23% HSIL, with retro review 23% HSIL, 30% ASCUS, 14% unsatisfactory30% ASCUS, 14% unsatisfactoryPaavonenPaavonen et alet al -- 21% progression to HSIL on biopsy 21% progression to HSIL on biopsy after “after “metaplasticmetaplastic cell cell atypiaatypia””

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CASE 9CASE 9

91 year old91 year oldPap smear ASCUS r/o HSILPap smear ASCUS r/o HSIL

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High Grade High Grade SquamousSquamousIntraepithelial LesionIntraepithelial Lesion

Atrophy vs. HSIL/SCCAtrophy vs. HSIL/SCCClues to a serious nature:Clues to a serious nature:

Increased nuclear sizeIncreased nuclear sizeExtreme Extreme hyperchromasiahyperchromasia, crowding, crowdingNuclear membrane irregularityNuclear membrane irregularityLoss of spectrum which links clearly benign Loss of spectrum which links clearly benign atrophic cells to those with more atrophic cells to those with more atypiaatypiaRecommend repeat pap with estrogen or Recommend repeat pap with estrogen or colposcopycolposcopy and biopsyand biopsy

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Case 10Case 10

30 year old 30 year old Pap smear Pap smear -- HSILHSIL

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TrophoblasticTrophoblastic TissueTissue

Rare, may be seen in late pregnancy or Rare, may be seen in late pregnancy or following deliveryfollowing deliveryNumerous cells suggest Numerous cells suggest trophoblastictrophoblasticdiseasediseaseNot reliable as indicator of impending Not reliable as indicator of impending abortionabortion

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TrophoblasticTrophoblastic TissueTissue

DecidualDecidual Cells DDXCells DDXDysplasiaDysplasiaRepairRepairCarcinomaCarcinomaSarcomaSarcoma

Multinucleated Giant Cells In PregnancyMultinucleated Giant Cells In PregnancySyncytiotrophoblastSyncytiotrophoblastMultinucleated giant cell Multinucleated giant cell histiocyteshistiocytesHerpesHerpesTumorTumorDysplasia/CondylomaDysplasia/Condyloma

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Case 11Case 11

33 year old 33 year old Pap smear Pap smear -- HSILHSIL

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Menstrual ChangesMenstrual Changes

Menstrual endometrial cellsMenstrual endometrial cellsResembles AISResembles AISPoorly preserved cellsPoorly preserved cellsHyperchromasiaHyperchromasia of degenerationof degenerationStromalStromal balls and balls and histiocyteshistiocytesAbsence of feathering and rosettesAbsence of feathering and rosettes

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False positiveFalse positive

Lower uterine segmentLower uterine segmentresembles AISresembles AISuniform small cells in sheets or tubulesuniform small cells in sheets or tubuleslack of lack of featheringorfeatheringor rosettesrosettesfine, even chromatinfine, even chromatinspindled spindled stromalstromal cells attachedcells attachedmay have mitotic figuresmay have mitotic figures

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Case 12Case 12

42 year old42 year oldpap smear was called HSILpap smear was called HSIL

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Endometrial Endometrial AdenocarcinomaAdenocarcinoma

Overall features dependent upon gradeOverall features dependent upon gradeIncreased N/C ratioIncreased N/C ratioHyperchromasiaHyperchromasiaIrregular chromatin distributionIrregular chromatin distributionProminent nucleoliProminent nucleoliDiathesisDiathesis

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Abnormal Shedding of Abnormal Shedding of Endometrial CellsEndometrial Cells

EndometritisEndometritisEndometriosisEndometriosisSubmucosalSubmucosal leiomyomaleiomyomaEarly pregnancyEarly pregnancyAbortionAbortionIUDIUDInstrumentationInstrumentationHormonal therapy (BCP, ERPT)Hormonal therapy (BCP, ERPT)DUBDUBEndometrial polypEndometrial polypEndometrial hyperplasia, Endometrial hyperplasia, neoplasianeoplasia

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Endometrial Endometrial AdenocarcinomaAdenocarcinoma DDXDDX

EndometritisEndometritisCrowded groups with nuclear enlargement and prominent Crowded groups with nuclear enlargement and prominent nucleoli, ballsnucleoli, ballsIncreased Increased neutrophilsneutrophilsUniform nuclei, smooth nuclear membranes and regular Uniform nuclei, smooth nuclear membranes and regular chromatinchromatin

EndocervicalEndocervical AdenocarcinomaAdenocarcinomaMore More cellularitycellularityRosettesRosettesGranular cytoplasmGranular cytoplasmMultinucleationMultinucleation commoncommonCEA+CEA+

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Case 13 Case 13

55 year old55 year oldPap smear was called AGUS, Pap smear was called AGUS,

EndometrialEndometrial

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Fallopian Tube Fallopian Tube AdenocarcinomaAdenocarcinoma

PostmenopausalPostmenopausalNulliparousNulliparous, usual, usualDiagnosis of exclusion:Diagnosis of exclusion:

Negative cone biopsyNegative cone biopsyNegative D and CNegative D and CNo known primary tumorNo known primary tumor

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SummarySummary

FeatureFeature ReactiveReactive AISAIS InvasiveInvasive

CrowdingCrowding +/+/-- ++++++ ++++

FeatheringFeathering 00 ++++++ ++++

RosettesRosettes +/+/-- ++++++ ++++

CiliaCilia +/+/-- 00 00

MitosesMitoses +/+/-- ++++ ++++

Nuclear Nuclear irregularityirregularity

00 ++ ++++++

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SummarySummary

FeatureFeature ReactiveReactive AISAIS InvasiveInvasive

Irregular Irregular chromatinchromatin

00 +/+/-- ++++++

High N/CHigh N/C +/+/-- ++++++ ++++

NucleoliNucleoli VariableVariable 0 or 0 or micronucleolimicronucleoli

MacronucleoliMacronucleoli

Normal Normal endocervicalendocervicalcellscells

++++++ ++++ ++

BackgroundBackground Clean/InflammatoryClean/Inflammatory InflammInflamm./Clean./Clean DiathesisDiathesis

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ReferencesReferences

DeMayDeMay RM. The Art and Science of RM. The Art and Science of CytopathjologyCytopathjology--ExfoliativeExfoliative Cytology. ASCP Cytology. ASCP Press 1996Press 1996


A Dissertation on CYTOLOGIC SPECTRUM OF SALIVARY …

Basic Histologic & Cytologic Techniques

Crowded Places Checklists

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CROWDED URBAN SPACES

Crowded Coasts

Cytologic and DNA-cytometric early diagnosis of oral cancerdownloads.hindawi.com/journals/acp/2001/807358.pdf · T.W. Remmerbach et al. / Cytologic and DNA-cytometric early diagnosis

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Abnormal Event Detection in Crowded Scenes using Sparse ...jsyuan/papers/2013/Abnormal Event Detection in Crowded Scenes...detection can be classified into those in crowded scenes

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Orthodontic treatment for crowded teeth in children · Orthodontic treatment for crowded teeth in children Fyeza N Janjua Sharif Background: Crowded teeth develop when there is not

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The Crowded City

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Cytologic Changes in Tears During the Late Type of ...cdn.intechopen.com/pdfs/24291/InTech-Cytologic_changes...Cytologic Changes in Tears During the Late Type of Secondary Conjunctival

Crowded Single LEA Symbols Visual Acuity Test at 5 feet · 1.800.362.3860 1.888.362.2576 Fax VIP Crowded Acuity Test 4 1.800.362.3860 Crowded Single LEA Symbols® Visual Acuity Test

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Crowded coasts past papers

CYTOLOGIC APPROACH TO PANCREATIC SOLID TUMORS Mostafa Fraig, MD University of Louisville, Louisville, KY

Crowded Collaborative Virtual Environments

The crowded nest

Hyperchromatic Crowded Groups: What is Your Diagnosis … · Hyperchromatic Crowded Groups Term introduced by Dr. DeMay in the mid 90’s . Refers to cellular “microbiopsies”

Mycosis fungoides6 - DermpathMD.comdermpathmd.com/cases/slide atlas/Mycosis fungoides6.pptx.pdf · Pearls% Atypicalintraepidermal) lymphocytes)with) hyperchromatic)and) hyperconvolutednuclear)

Crowded Coasts Revision Booklet

Empty Nests, Crowded Houses

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Integrated Cytologic and Proteomic Analysis of …pinheiro/CP_PDFs/2012_ASIC.pdf · Integrated Cytologic and Proteomic Analysis of Coffea Arabica – Hemileia Vastatrix Interactions

Is your event "Crowded"?

Pathology of HPV infection at the cytologic and histologic ... of HPV infection at the cytologic and.pdfHuman papillomavirus (HPV) Abstract Over the last 2 decades the pathogenesis

Crowded House

Crowded House.pdf

Crowded Field Spectroscopy