Edorium Journal of

Gynecology and Obstetrics

 
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Editorial
 
HPV-induced cervical glandular lesions can be overstated on Pap smear
Teresa Pusiol1, Francesco Piscioli1, Luca Roncati1,2
1Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, Rovereto (TN), Italy.
2Department of Diagnostic and Clinical Medicine and of Public Health, University of Modena and Reggio Emilia, Modena (MO), Italy.

Article ID: 100005G06TP2015
doi:10.5348/G06-2015-5-ED-5

Address correspondence to:
Dr. Luca Roncati
Department of Diagnostic and Clinical Medicine and of Public Health
University of Modena and Reggio Emilia
Policlinico Hospital, I-41124 Modena (MO)
Italy
Phone: +390594224812
Fax: +390594224998

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Pusiol T, Piscioli F, Roncati L. HPV-induced cervical glandular lesions can be overstated on pap smear. Edorium J Gynecol Obstet 2015;1:17–18.

It is well known the utility of human papilloma virus (HPV) testing in young women with atypical glandular cells (AGC) on Pap test. In fact, HPV testing may be useful in risk stratifying young women with AGC on Pap test, because they are at risk of having an HPV-positive cervical lesion [1]. It can happen to histologically observe occasional cases of HPV-positive glandular cervical dysplasia/metaplasia, labeled as adenocarcinoma on Pap smear. In these cases, the Pap smear reveals atypical cervical cells, characterized by increased size, irregular outline, nuclear hyperchromasia, prominent nucleoli, dense chromatin and inversion of the nucleus/cytoplasm ratio. These atypical cells can be sometimes arranged in a floral pseudo-glandular fashion (Figure 1A). For this reason, a cytological suspicion of adenocarcinoma can be formulated and the patient is submitted to cervical conization. However, the final histopathological examination shows only a glandular cervical dysplasia/metaplasia, characterized by pseudo-stratified and stratified lining epithelium, enlarged hyperchromatic nuclei with mild polymorphism and occasional apoptosis. Nucleoli are scantly noticeable, while mitotic figures or cribriform/ papillary formations are completely absent (Figure 1B) and (Figure 1C). Moreover, the dysplastic/metaplastic glands can result immunoreactive for p16 protein (Figure 1D) and HPV DNA can be ascertained by molecular biology. Thanks to our experience, on pap smear it is not possible to distinguish endocervical adenocarcinoma in situ from HPV-positive glandular dysplasia/metaplasia, which appears to be an its possible precursor. A well representative Pap smear can allow an early diagnosis of this insidious HPV-induced lesion, avoiding the under-treatment of a possible cancer precursor [2]. At the same time, the application of HPV testing in childbearing age women with AGC on Pap test can initially direct to a fertility-spearing treatment, with the awareness that behind these atypical cells there may be a non-invasive HPV-induced lesion.

Keywords: Atypical glandular cells (AGC), Human papilloma virus (HPV), Pap smear, Uterine cervix


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Figure 1: On Pap smear (A) the atypical glandular cells are arranged in a floral pseudo-glandular fashion (yellow circle) (Papanicolaou stain, x40), (B) On histopathological examination, a dysplastic/metaplastic gland (yellow arrow) is seen near to normal cervical glands, pointed out by black arrows (H&E stain, x10), (C) At higher magnification, the dysplastic/metaplastic gland shows pseudo-stratified and stratified lining epithelium, enlarged hyperchromatic nuclei and occasional apoptosis. No mitotic figures are observable, (D) The dysplastic/metaplastic glands can result immunoreactive for p16 (magnification, x20).


References
  1. Crothers JW, Mount SL, Harmon M, Wegner E. The utility of human papillomavirus testing in young women with atypical glandular cells on pap test. J Low Genit Tract Dis 2015 Jan;19(1):22–6.   [CrossRef]   [Pubmed]    Back to citation no. 1
  2. Kindelberger DW, Krane JF, Lee KR. Glandular neoplasia of the cervix. In: Crum CP, Nucci MR, Lee KR eds. Diagnostic gynecologic and obstetric pathology. Philadelphia, PA: Elsevier Saunders; 2011:328–78.    Back to citation no. 2

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Author Contributions:
Teresa Pusiol – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Francesco Piscioli – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Luca Roncati – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Teresa Pusiol et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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