Ravirani Samuel, Manal M.M. Abdulrazzaq, Badr Abdullgaffar, Hassan y. Hotait and Mouza Al-Sharhan
The Bethesda system; Atypical glandular cells; ThinPrep Pap test; Adenocarcinoma.
|PUBLISHED DATE||October 2016|
|PUBLISHER||The Author(s) 2016. This article is published with open access at www.chitkara.edu. in/publications|
Objective : This study was undertaken to analyze the prevalence and spectrum of atypical glandular cells to investigate its clinical significance in our population. Study design : A 5 year retrospective review of atypical glandular cells diagnosed on ThinPrep pap test was performed. AGC were reported in 40 patients, who underwent colposcopy- directed biopsy, endocervical curettage and endometrial curettage to determine the cytological and histological correlations of AGC. Results : The prevalence of AGC was 0.2% out of 19836 patients. The patients age ranged from 29 to 81 years (mean age 49.4 years). Significant lesions were defined as Squamous Intraepithelial lesion (SIL), adenocarcinoma in situ (AIS) or invasive carcinoma. This included 2 invasive squamous cell carcinoma of the cervix, 2 high grade squamous intraepithelial lesions, 2 AIS, 5 adenocarcinoma of the cervix, two of which had low grade and high grade squamous intraepithelial lesions one of which was consistent with metastastic colonic carcinoma and 5 endometrial adenocarcinoma, one of which was suspicious of breast carcinoma. The chi-square value was significant at 99% confidence interval. Conclusion : AGC were associated with clinically significant lesions in 40% of our cases.. Significant endocervical glandular lesions occurred in younger women whereas the older women had endometrial lesions.. Patients with AGC should be followed up for a substantial period despite initial negative histological findings.
The Bethesda System (TBS) in 1988 introduced the term atypical glandular cells of undetermined significance (AGUS) as a diagnostic category for the endocervical or endometrial glandular cells that demonstrate nuclear atypia appearing to exceed reactive or reparative changes but lacking unequivocal features of adenocarcinoma. . In 2001 the classification of glandular abnormalities was significantly revised. The term AGUS has been eliminated and the glandular cell abnormalities are classified into three categories; atypical glandular cells (AGC) either endocervical, endometrial cells or ‘glandular cells’ “not otherwise specified” (AGC-NOS) and favor neoplasia (AGC-FN) and endocervical adenocarcinoma in situ (AIS) . AGC is an uncommon cytological diagnosis occurs in approximately 0.18-0.74% of cervical smears . On further evaluation 50-85 percent of women with AGC will have no histological abnormalities . Some studies have reported that the risk of premalignant and malignant conditions, ranging from 17-59 percent  The origin of benign, premalignant or malignant lesions that presents as atypical glandular cells varies with the age of the patient. Cervical pathology is more likely in younger women where as in older women the endometrium is the more likely origin of atypical glandular cells . The AGC represents a wide variety of clinically benign lesions to clinically significant premalignant or malignant lesions. The benign lesions associated with AGC are chronic cervicitis, endometriosis, squamous metaplasia, tubal metaplasia, microglandular hyperplasia, pregnancy, previous cone biopsy, radiation and cervical polyps . The clinically significant premalignant or malignant lesions include squamous cervical intraepithelial neoplasia (CIN), adenocarcinoma in situ (AIS) of the cervix, complex endometrial hyperplasia, malignancy of the lower and upper genital tracts and rarely abdominal or distant non reproductive organs  Over the past few decades the incidence of cervical adenocarcinoma in situ (AIS) and adenocarcinoma has been increasing . Although the cervical cytology screening can be used to detect squamous lesions with a low sensitivity for glandular lesions, it offers the potential for the prevention of cervical adenocarcinoma by detecting the precursor adenocarcinoma in situ (AIS)  and also enhances the opportunity to detect endometrial abnormalities in some cases.
The purpose of our retrospective study was to analyze the prevalence and spectrum of atypical glandular cells to investigate its clinical significance in our local population.
|ISSN||Print : 2393-8536, Online : 2393-8544|
The prevalence of AGC in our study was 0.2% and its associated significant pathologic findings found in our population were similar to that of large institution based studies. The presence of atypical glandular cells in cervical smears may exhibit a spectrum of findings from benign or reactive changes to squamous or glandular malignant or pre malignant lesions. This review showed significant endocervical lesions occurred in younger women where as the older women had endometrial lesions. Patients with atypical glandular cells with the clinical presentation of abnormal vaginal bleeding and post menopausal status should be followed up closely. As patients with AGC are at risk for clinically significant lesions should be followed up for a substantial period despite initial negative histological findings.