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Synchronous high‐grade squamous intraepithelial lesion and adenocarcinoma in situ of cervix in a young woman presenting with hyperchromatic crowded groups in the cervical cytology specimen: Report of a case
Author(s) -
Zafar Nadeem,
Balazs Louisa,
Benstein Barbara D.
Publication year - 2008
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.20932
Subject(s) - medicine , cytology , cervix , squamous intraepithelial lesion , biopsy , pathology , adenocarcinoma , cytopathology , carcinoma in situ , intraepithelial neoplasia , cervical intraepithelial neoplasia , hpv infection , not otherwise specified , immunohistochemistry , gynecology , liquid based cytology , carcinoma , cervical cancer , cancer , prostate
We report a 29‐year‐old woman who underwent routine gynecologic evaluation at a community clinic and had a cervical sample drawn for liquid‐based cytologic evaluation. At cytology, many hyperchromatic crowded groups (HCG) were present, but a consensus could not be established whether the abnormal cells were primarily glandular or squamous with secondary endocervical glandular involvement. An interpretation of atypical endocervical cells, favor neoplastic, was rendered and biopsy advised if clinically appropriate. At biopsy, the cervix contained synchronous squamous cell carcinoma in situ, secondarily involving endocervical glands, and neighboring adenocarcinoma in situ. Immunohistochemistry for Ki‐67 and p16 INK4A crisply and precisely stained both the lesions, clearly separating them from the adjacent uninvolved mucosa. This case re‐emphasizes the challenge associated with accurate evaluation of HCG at cytology, the significance of ancillary testing for surrogate markers of high‐risk HPV (HR‐HPV) infection, the need for adjunct testing for HPV‐DNA in the setting of HCG at cervical cytology, and a recommendation to set up studies to evaluate the role of surrogate markers of HR‐HPV infection in cytologic samples with HCG. Diagn. Cytopathol. 2008;36:823–826. © 2008 Wiley‐Liss, Inc.