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Cytomorphological Features of Hyperchromatic Crowded Groups in Liquid-Based Cervicovaginal Cytology: A Single
Youngeun Lee1, Cheol Lee1, In Ae Park1
1Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Insights
Hyperchromatic crowded groups (HCGs) are common in cervicovaginal cytology, often indicating non-neoplastic conditions like atrophy. However, HCGs can also signify high-grade neoplastic lesions, necessitating careful cytomorphological evaluation to prevent misinterpretation.
Area of Science:
- Gynecologic Pathology
- Cytopathology
- Cervical Cancer Screening
Background:
- Hyperchromatic crowded groups (HCGs) are common findings in cervicovaginal liquid-based cytology (LBC).
- These are characterized as three-dimensional aggregates of crowded cells with hyperchromatic nuclei.
- Their prevalence and diagnostic significance require further investigation.
Purpose of the Study:
- To determine the prevalence of HCGs in cervicovaginal LBC.
- To analyze the cytomorphological characteristics of epithelial cell clusters presenting as HCGs.
- To assess the association of HCGs with neoplastic lesions.
Main Methods:
- Examined HCG prevalence in a routine LBC cohort (n=331) and a high-grade epithelial cell abnormality (H-ECA) cohort (n=69).
- H-ECA cohort included diagnoses of high-grade squamous intraepithelial lesion (HSIL), squamous cell carcinoma (SCC), and adenocarcinoma.
- Cytomorphological features of HCGs and surrounding cells were analyzed.
Main Results:
- HCGs were found in 34.4% of the routine cohort, significantly more frequent in abnormal cell categories.
- Atrophy was the most common finding (70%) within HCGs in the routine cohort.
- All 69 H-ECA cases contained HCGs, predominantly HSIL (62%) and SCC (16%).
- Individually scattered neoplastic cells were more frequent in SCCs than glandular neoplasia.
- Edges and focal planes of HCGs aided in interpretation.
Conclusions:
- HCGs are frequently observed in cervicovaginal LBC, with most being non-neoplastic.
- Neoplastic HCGs are often associated with high-grade lesions (HSIL, SCC).
- Understanding HCG cytomorphology is crucial to avoid false-negative interpretations in cytology.
Background:
Hyperchromatic crowed groups (HCGs) are defined as three-dimensional aggregates of crowded cells with hyperchromatic nuclei, and are frequently encountered in cervicovaginal liquid-based cytology (LBC). Here, we aimed to examine the prevalence of HCGs in cervicovaginal LBC and the cytomorphological characteristics of various epithelial cell clusters presenting as HCGs.
Methods:
We first examined the prevalence of HCGs in a "routine cohort" of LBC cytology (n=331), consisting of all cervicovaginal LBCs accessioned over 3 days from outpatient clinics (n=179) and the screening population (n=152). Then we examined a second "high-grade epithelial cell abnormalities (H-ECA) cohort" (n=69) of LBCs diagnosed as high-grade squamous intraepithelial lesion (HSIL), squamous cell carcinoma (SCC), or adenocarcinoma during 1 year.
Results:
HCGs was observed in 34.4% of the routine cohort and were significantly more frequent in the epithelial cell abnormality category compared to the non-neoplastic category (p=.003). The majority of HCGs represented atrophy (70%). Of the 69 histologically confirmed H-ECA cases, all contained HCGs. The majority of cases were HSIL (62%), followed by SCC (16%). Individually scattered neoplastic cells outside the HCGs were significantly more frequent in SCCs compared to glandular neoplasia (p=.002). Despite the obscuring thick nature of the HCGs, examining the edges and the different focal planes of the HCGs and the background were helpful in defining the nature of the HCGs.
Conclusions:
HCGs were frequently observed in cervicovaginal LBC and were mostly non-neoplastic; however, neoplastic HCGs were mostly high-grade lesions. Being aware of the cytomorphological features of different HCGs is important in order to avoid potential false-negative cytology interpretation.
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