Nov2005: Letters to the Editors

I read with interest the article by Ozkan and colleagues1 on glandular lesions of the cervix on thinlayer Pap tests. However, a few clarifications need to be made. The authors commented on the difficulty distinguishing endocervical adenocarcinoma in situ (AIS) from high grade squamous intraepithelial lesion (HSIL) involving endocervical glands. Of the 37 ThinPrep® Pap TestsTM (Cytyc Corporation, Boxborough, Massachusetts, U.S.A.), 15 showed squamous intraepithelial lesions on follow-up cervical biopsy; of these, 4 showed HSIL with endocervical gland involvement. The authors commented that maintenance of cell polarity in HSIL involving endocervical glands is often seen on ThinPrep® Pap TestsTM. They stated that the cytologic feature of loss of cell polarity in HSIL involving endocervical glands, previously reported on conventional smears,2 may not be present on thin-layer slides. This has not been my experience.3 A 2-year retrospective study produced 97 cases of cervical intraepithelial neoplasia (CIN) 3, 52 (54%) of which showed endocervical gland involvement by CIN 3. There were also 6 cases of AIS. The ThinPrep® Pap TestsTM from these cases were reviewed. The architectural features of HSIL involving endocervical glands were similar to those previously reported on conventional smears. A consistent finding of HSIL involving endocervical glands was the loss of central cell polarity and piling within cell groups, a finding not present in AIS. Central cell polarity was maintained in cellular groupings of AIS. In addition to the cellular features present on conventional smears, micronucleoli were present in cells of HSIL involving endocervical glands, and prominent nucleoli were present in AIS. Apoptosis and mitoses were seen in both entities. Characteristic cytologic features of these entities on ThinPrep® Pap TestsTM are listed in Table I. The cytologic features of HSIL involving endocervical glands and AIS on ThinPrep® cytology are similar to those on conventional smears. However, additional findings include the presence of visible micronucleoli in HSIL involving endocervical glands and the presence of mitoses and apoptosis in both entities. Hopefully, these findings will be of benefit to those who interpret ThinPrep® Pap TestsTM.