Pap test je citlivým testem pro CIN a ?asné fáze invazivního skvamózního karcinomu cervixu je však mén? citlivý v detekci adenokarcinomu. Pravd?podobnost záchytu se zvyšuje rutinním užitím endocervikálního kartá?ku , který zajistí odb?r z kanálu.
Adenocarcinoma in situ (AIS) Odlišit in situ adenokarcinom a dob?e diferencovaný invazivní adenokarcinom cytologicky je nesnadné. U AIS jsou v jednom nát?ru p?ítomny normální a abnormální cylindrický epitel a pozadí je zpravidla ?isté.
V dob?e diferencovaném adenokarcinomu jsou žlázové bu?ky v plošných formacích, trsech, proužcích, a rozetách. Jednotlivé bu?ky jsou zjevn? cylindrické a mohou tvo?it palisády nebo plástve. V?tšinou jsou dob?e zachovalé.
Na rozdíl od normálních palisád jádra mají r?znou velikost a tvar. To je nejlépe vid?t na okrajích trs?.
V plástvích jsou jádra nat?snána a p?ekrývají se, což dodává shluk?m bun?k hyperchromní charakter, a?koli v jednotlivých bu?kách je chromatin jemn? granulární. Mohou být p?ítomny nukleoly a mitózy.
V st?edn? a málo diferencovaných adenokarcinomech je žlázový p?vod bun?k mén? z?ejmý a cytologické znaky r?znorod?jší. Bun??né trsy jsou t?sn? nahlou?ené, na okrajích a jednotlivých bu?kách však lze žlázový p?vod n?kdy rozpoznat. Mohou být z?ejmá zv?tšení jader, anizokaryóza zv?tšená a více?etná jadérka a mitózy.
Pozadí : v adenocarcinoma in situ a ?asných stadiích adenokarcinomu je pozadí zpravidla ?isté. V pokro?ilejších nádorech obsahuje pozadí ?erstvou a starší krev , polynukleáry, nekrotický detritus (tzv. nádorová diatéza.).
Abnormální dlaždicové bu?ky mohou být p?ítomny v p?ípad? konkomitantní skvamózní léze.
Adenocarcinoma in situ:
Cervical scrapes from a focus of AIS are often very cellular containing numerous sheets of glandular cells. This in itself should raise suspicion of glandular neoplasia unless the specimen has been taken with an endocervical brush. In this slide the nuclei are crowded , hyperchromatic but their columnar shape can be readily recognised.Note the clean background. Sheets of normal endocervical epithelium were also found in the smear. Note clean background.A cluster of neoplastic cells from a focus of AIS. There is some loss of polarity, variation in nuclear size and an obvious nuclear hyperchromasia but the honeycomb pattern can still be discerned. The distinction between AIS and invasive adenocarcinoma cannot be made with a high degree of certainty
Dob?e diferencovaný endocervikální adenokarcinom
Endocervical adenocarcinoma; Sheet of glandular cells in cervical smear showing “feathering “ and palisade formation at the edges of the sheet.Adenocarcinoma showing palisade formation at higher magnification Note uneven distribution of the nuclei in the palisadeEndocervical adenocarcinoma :Strips of crowded columnar cells showing pseudostratifiction with dense overlapping nuclei but the glandular architecture is still preserved.Invasive endocervical adenocarcinoma: a three dimensional cluster of glandular cells. Apart from the background the morphology is similar to that found in AISEndocervical adenocarcinoma (poorly differentiated) Nuclei are large pleomorphic with irregular chromatin and the cytoplasm is abundant and delicate but little of the glandular architecture is retained.
Metastatický endocervikální adenokarcinom
Other malignant neoplasms: Endometrial carcinoma in a cervical smearOther malignant neoplasms: Metastatic colon adenocarcinoma in a cervical smearEndocervical adenocarcinoma(poorly differentiated): The cluster is composed of undifferentiated tumour cells with scant cytoplasm and nuclei which vary in size. The delicate chromatin structure of the nuclei and the macronucleoli are consistent with adenocarcinoma.Other malignant neoplasms: Ovarian carcinoma in a cervical smears
Endocervical adenocarcinoma:There is little to distinguish this hyperchromatic cluster of malignant glandular cells form those found in a poorly differentiated squamous carcinoma.
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