Glandular Cell Abnormalities
Endometrial Cells. The presence of endometrial cells, cytologically benign, in a postmenopausal woman not receiving exogenous hormones should be investigated even when the cells are normal in appearance. Such cells may be associated with inadvertent sampling of the lower uterine segment, endometrial polyps, endometrial hyperplasia, or carcinoma. If the patient is taking hormone therapy, endometrial cells can be normal. (Endometrial cells on a Pap test from a pre-menopausal woman are considered a normal finding regardless of the phase of the menstrual cycle.)
Atypical Glandular Cells of Undetermined Significance. The term “atypical glandular cells of undetermined significance” is used to report changes beyond those encountered in the benign reactive processes but insufficient for a diagnosis of adenocarcinoma. The report should indicate whether the cells are thought to be of endocervical or endometrial origin, when possible.
Adenocarcinoma. A report of adenocarcinoma indicates a probable invasive tumor. The report should specify whether an endometrial, endocervical, or extrauterine site is suspected.
Other Neoplasias. Other malignant neoplasms may be suspected on the basis of certain cytologic findings. These include small cell carcinoma, melanoma, lymphoma, and sarcoma. When originally published, the Bethesda System included a directive for the cytopathologist to make a recommendation for further patient evaluation when appropriate. This recommendation was deleted in the second Bethesda workshop. The cytology report should not attempt to direct therapeutic management of the patient, but may include suggestions for additional cytologic or tissue evaluation if the cytopathologist believes that additional material will assist in clarifying the diagnosis. When atypical squamous cells are associated with atrophy, the cytopathologist may suggest estrogen therapy to help resolve the diagnostic uncertainty.
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