Endocervical Adenocarcinoma In Situ<\/p>\n
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Criteria<\/p>\n
Tissue Presentation Cytoplasm N\/C Nucleus <\/strong><\/p>\n Nuclear Membrane<\/strong><\/p>\n Chromatin Nucleoli Look Alikes for Endocervical Adenocarcinoma in situ<\/p>\n Tubal Metaplasia:<\/p>\n Cell Type: <\/strong>Small cuboidal fallopian tube-type glandular<\/p>\n Tissue Presentation <\/strong><\/p>\n Unique Features <\/strong><\/p>\n Lower Uterine Segment:<\/p>\n Cell Type:<\/strong> Endometrial Lower uterine segment may have prominent nucleoli. 40X<\/p><\/div>\n<\/div>\n Unique Features HSIL in Glands:<\/p>\n Tissue Presentation<\/strong><\/p>\n HSIL involving the gland space – 40x<\/p><\/div>\n<\/div>\n Cytoplasm HSIL in glands – Finely vacuolated cytoplasm, with ill defined borders, creates a frayed appearance. 40x<\/p><\/div>\n<\/div>\n Nucleus HSIL – Nuclei show variability in shape (round to oval) and size. 40x<\/p><\/div>\n<\/div>\n Nuclear Membrane HSIL – Nuclei show irregularities within the membrane creating bites and divots. 60x<\/p><\/div>\n<\/div>\n Chromatin
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\nA strip of endocervical cells exhibiting pseudostratification and finely vacuolated cytoplasm with indistinct cytoplasmic borders. Architecture is disrupted although cells are still attempting to maintain a glandular configuration. Note increased N\/C ratio and the variable presence of nucleoli. Biopsy – AIS – 60x<\/div>\n<\/div>\n
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\nEndocervical cells presenting in a pseudo-rosette formation and exhibiting “feathering” and nuclear elongation due to crowding. Biopsy – AIS – 60x<\/div>\n<\/div>\n
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\nVariably sized, crowded, hyperchromatic groups of cells are seen on screening power which warrant a closer inspection. 20x<\/div>\n<\/div>\n
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\nEndocervical cells presenting in a strip with pronounced nuclear crowding. Biopsy – AIS – 60x<\/div>\n<\/div>\n
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\nThis crowded, stratified group of glandular cells comes from a case of AIS. Note the basal nuclei piling up from the lower layer of the epithelium. 60x<\/div>\n<\/div>\n
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\nAIS – 60x<\/div>\n<\/div>\n
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\nA strip of endocervical cells exhibiting pseudostratification and finely vacuolated cytoplasm with indistinct cytoplasmic borders. Architecture is disrupted although cells are still attempting to maintain a glandular configuration. Note increased N\/C ratio and the variable presence of nucleoli. Biopsy – AIS – 60x<\/p>\n<\/div>\n<\/div>\n
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\nHigh N\/C ratios are evident in nuclei that take up at least 2\/3 of the cytoplasm. Chromatin is coarse but evenly distributed and micronucleoli are present. Biopsy – AIS – 60x<\/div>\n<\/div>\n\n
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\n<\/strong> Endocervical cells presenting in a pseudo-rosette formation and exhibiting “feathering” and nuclear elongation due to crowding. Biopsy – AIS – 60x<\/div>\n<\/div>\n
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\nNuclear elongation is clearly evident in this group of atypical endocervical cells. Also noted is loss of nuclear polarity, loss of normal architecture, nuclear crowding, and “molding” of the nuclei. Note the flat nuclear membranes where they push up against each other (a sign of true crowding). Biopsy – AIS – 60x<\/div>\n<\/div>\n\n
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\nAIS – 60x<\/div>\n<\/div>\n
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\nNucleoli can be indistinct to prominent. In this image, the nucleoli are prominent and present in a majority of the nuclei. Rapid fixation makes the presence of nucleoli another important piece of criteria in the diagnosis of AIS.
\nBiopsy – AIS – 60x<\/div>\n<\/div>\n\n
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\nTubal metaplasia can closely mimic AIS. However, on close inspection the abnormalities, ie: crowding, nuclear elongation, irregular nuclear membranes and abnormal tissue fragments are less severe. Locating cilia and\/or terminal bars confirms benignancy. 60X<\/div>\n<\/div>\n
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\nCrowded glandular cells have enlarged nuclei but a closer inspection reveals evenly distributed chromatin. 40x<\/div>\n<\/div>\n\n
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\nA strip of columnar cells with hyperchromatic, crowded nuclei. Close observation reveals distinct cytoplasmic vacuoles and cilia possibly representing tubal metaplasia. 60X<\/div>\n<\/div>\n
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\nIn this higher power view of the first photograph (20x) a distinct row of cilia is evident. 60x<\/div>\n<\/div>\n
\nTissue Presentation
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\nA fragment of cells from the lower uterine segment, which has folded over itself causing a three dimensional appearance. 20X<\/div>\n<\/div>\n
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\nLower uterine segment – 40X<\/div>\n<\/div>\n
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\nThis tissue fragment of lower uterine segment is composed of small, cuboidal cells with uniform nuclei and bland chromatin. At low power the cells appear crowded; however on closer inspection they are simply tightly packed. The cohesiveness and uniformity of such fragments at low power are the keys to diagnosis. A stromal component is usually present as well and is an aid in diagnosis. 20x<\/div>\n<\/div>\n\n
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