Endocervical reactive atypia: a histologic-cytologic study

Area of Science:

• Gynecologic Pathology
• Cervical Cytology
• Surgical Pathology

Background:

• Reactive glandular atypia in endocervical cells can be challenging to distinguish from adenocarcinoma.
• Understanding the causes and cytologic features of reactive atypia is crucial for accurate diagnosis.

Purpose of the Study:

• To define the histologic and cytologic characteristics of reactive glandular atypia in endocervical tissues.
• To investigate potential associations of reactive atypia with inflammatory, regenerative, hormonal, or viral factors.
• To assess the clinical significance and follow-up of cases with reactive atypia.

Main Methods:

• Histologic examination of 1,500 cervical tissue specimens to identify cases with reactive glandular atypia.
• Review of concurrent cervico-vaginal smears for cytologic correlation.
• Examination of endocervical polyps and hysterectomy specimens to evaluate reactive changes.
• Analysis of clinical data, including hormonal usage and follow-up information.

Main Results:

• Twenty-seven cases (1.8%) showed histologic reactive glandular atypia, characterized by enlarged, hyperchromatic, irregular nuclei.
• Six of 18 reviewed smears showed similar cytologic atypia.
• Reactive atypia was observed in endocervical polyps and hysterectomy specimens, supporting its reactive nature.
• Associations were noted with hormonal usage (9/27) and squamous intraepithelial lesions/HPV (14/27).
• No progression to adenocarcinoma was observed during follow-up of the 27 index cases.

Conclusions:

• Endocervical reactive glandular atypia can be distinguished from adenocarcinoma based on defined histologic and cytologic criteria.
• Inflammatory-regenerative processes, hormonal influences, and possibly human papilloma virus are associated with reactive atypia.
• Reactive atypia does not appear to be a precursor lesion to endocervical adenocarcinoma.