Case Presentation - December, 2003


Age: 51 Year Old, Female

History: HR HPV +

Case provided by Drs. Harenberg and Konrad of Homburg, Germany. The images and diagnosis for this case study were provided by an independent laboratory.

Cytologic Interpretation: Atypical Endocervical Cells of Undetermined Significance. Histologic Interpretation: Negative. Cervical Polyp.

The presence of endocervical polyps often causes identifiable reactive and proliferative cellular changes on a pap test. Even occasional mildly atypical changes may be deemed within acceptable limits in an otherwise reactive background. In contrast, significant endocervical cell atypia, although rare in occurrence, may cause cytologists significant concern and difficulty. While normal and reactive endocervical cells can sometimes undergo extremes of alteration, they typically maintain acceptable N:C ratios, nuclear membrane regularity, active but velvety chromatin patterns and lack of true nuclear overlap. The cells presented in this case, however, do not adhere to many of these rules that generally apply to reactive endocervical processes.

In retrospect, the inflammatory background and degenerative features present in this case probably indicate an inflammatory component of this patient's cervical polyp as opposed to the necrosis and degeneration of a high grade pre-invasive endocervical lesion. Multinucleation, as demonstrated in Slides 0312 and 0316 also may support a diagnosis of a reactive endocervical process over atypia. Slides 0314 and 0316 show sharp cytoplasmic borders, another often benign characteristic of endocervical cells. While some rare cells show an increased N:C ratio and some nuclei are markedly enlarged, the majority of cells in these groups maintain a normal N:C ratio.

To learn more about glandular look-alikes and differential diagnoses, consult Section 5 of the ThinPrep® Pap Test Morphology Reference Atlas.