Case Presentation - Summer, 2005

NOTE: The diagnosis and analysis for this case study were provided by an independent physician. All conclusions and opinions are those of the physician and not Hologic, Inc.

History: 31 year old female, LMP 2 weeks and post-coital bleeding

Specimen Type: ThinPrep® Pap Test

Case provided by: Mt. Auburn Hospital, Cambridge, Massachusetts

Cytologic diagnosis: Atypical glandular cells, favor neoplasia.

Histologic diagnosis: Extensive Tubal Metaplasia

Tubal metaplasia is found in small groups or in pseudostratified crowded groups of glandular cells with enlarged, round to oval nuclei that can be pleomorphic. Hyperchromasia is evident but the chromatin is evenly distributed and finely granular. Chromocenters and small nucleoli are often present. Since many features of adenocarcinoma in situ (AIS) are mimicked in tubal metaplasia, the presence of cilia and/or terminal bars is the most helpful criteria to diagnose tubal metaplasia.

To further help distinguish tubal metaplasia from AIS it is important to remember that feathering and rosette arrangements are not seen as often in tubal metaplasia but goblet cells and peg cells may be identified in the glandular groups. Also, there is no significant loss of polarity or irregularly distributed chromatin.

Tubal metaplasia is a benign condition that occurs high in the endocervical canal with epithelium that resembles that of the fallopian tubes. It is often seen in conjunction with endometrial hyperplasia and other states of increased estrogen levels. Since it is a benign and naturally occurring event, there is no treatment for tubal metaplasia.

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