KCP 788 가톨릭중앙의료원 전공의 서성욱

Clinical History F/39 특이 병력 없음 건강검진시 부인과 이상소견 자궁경부 세포학검사 후 원추절제술 및 자궁 절제술 시행 슬라이드는 자궁경부 액상도말표본

Cytologic Findings Clusters of hyperchromatic crowded columnar cells Disorganized honeycombed arrangements Nuclear overlapping Feathering Bird tail Rosettes A few isolated atypical cells Enlarged nuclei Coarsely granular chromatin patterns Small and inconspicuous nucleoli Clean backgrounds with scattered inflammatory cells

Differential Diagnosis Endocervical Adenocarcinoma in Situ Endocervical Adenocarcinoma Tubal Metaplasia High-Grade Squamous Dysplasias Abraded endometrial cells

Endocervical Adenocarcinoma in Situ Hyperchromatic crowded groupings of cells Pseudostratified strips of columnar cells Epithelial rosettes (gland formations) Nuclear and cytoplasmic “feathering” Nuclear size twofold greater than the intermediate squamous cel l nucleus N:C increased beyond normal endocervical cells Coarsely granular, evenly distributed hyperchromatic chromatin Possible presence of small nucleoli Presence of mitotic figures and apoptotic bodies Not associated with a background “tumor” diathesis

Endocervical Adenocarcinoma Architectural features of AIS may be retained in well differentiated lesions: – Feathered group edges – Rosette formation – Pseudostratified strips Large numbers of abnormal cells present with many isolated cells Granular clinging, necrotic and bloody tumor diathesis Nuclei enlarged (greater than 2–3 times the size of an intermediate squamous cell nucleus) Chromatin is coarsely granular with heterogeneity and clearing Macronucleoli are common Mitoses and apoptotic bodies are commonly seen Cytoplasm is generally granular and finely vacuolated

Tubal Metaplasia Incomplete features of AIS Pseudostratified strips of cells Nuclear feathering Rosettes Finely granular, evenly distributed chromatin “Washed-out” appearance to nuclei Enlarged nuclei with pleomorphism Nucleus-to-cytoplasmic ratio increased Occasional mitoses and rare apoptotic bodies; and Cilia/terminal bars

Differential Points Endocervical Adenocarcinoma in Situ Endocervical Adenocarcinoma Tubal Metaplasia Pseudostratified strips of cells Common features Nuclear feathering Rosettes NucleoliSmallMacronucleoli ChromatinCoarsely granular, evenly distributed Coarsely granular with heterogeneity and clearing Finely granular, evenly distributed DiathesisBloody Necrotic Granular clinging Ciliapresent Isolated cellsMany

Diagonosis Endocervical adenocarcinoma in situ

Endocervical Adenocarcinoma In Situ Normal endocervical cytology The incidence of AIS is a mere 0.61/100,000 which is 2% that of CIN 3 In practice, one is likely to see one case of AIS for every 50 cases of HSIL