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THE BETHESDA SYSTEM & EVALUATION OF A PAP SMEAR IN GLANDULAR CARCINOMA

Lailatul Jalilah, M. R. , Adibah, A. R. , Mohd Hairi, A. , Siti Mariam, M. , Siti Najihah, M., Norhalifah Hanim, K., Siti Amalina, M. R. BACHELOR OF MEDICAL LAB TECHNOLOGY (HONS) , FACULTY OF HEALTH SCIENCE , UNIVERSITI TEKNOLOGI MARA , PUNCAK ALAM CAMPUS , 42300 BANDAR PUNCAK ALAM, SELANGOR.

IINTRODUCTION

ALGORITHM

ENDOMETRIAL ADENOCARCINOMA

EXTRAUTERINE ADENOCARCINOMA

CONCLUSION

ENDOCERVICAL ADENOCARCINOMA

Figure 4 : nuclear enlargement, size of nuclei is variable, prominent macronucleoli , irregular chromatin distribution , nuclear membrane

irregularities, scanty cytoplasm.

Adenocarcinoma is a cervical cancer that originates in the mucus-producing cells of the inner or endocervix, near the body of the uterus. Cervical adenocarcinoma is most common in women over 457.9% all cancer cases admitted to government hospitals are derived from cervical cancer.

• Common method of collection: PAP Smear

• Types of Glandular adenocarcinoma: Endocervical adenocarcinoma Endometrial adenocarcinoma Extrauterine adenocarcinoma

Figure 3 : nuclear enlargement , pleomorphic nuclei seen, irregular chromatin distribution and necrotic background of smear

Figure 6 : Nuclear abnormalities, including nuclear enlargement or nucleoli, moderate hyperchromasia, loss of polarity and a watery

diathesis are clues to the diagnosis

Figure 7 : Showing a cluster of adenocarcinoma with glandular pattern with cells displaying high N: C ratio, vesicular nuclei,

prominent nucleoli and scanty to moderate cytoplasm.

Figure 5 : cells in cluster , prominent macronucleoli seen, large overlapping of nuclei and tumor diathesis may be less prominent.

(R M, 2000) and (Solomon & Nayar ,2004)

(Kondo, Hashi, Murata, & Nakazawa, ,2005) and (Solomon & Nayar ,2004)

(R M ,2000) and ( Leopold G. Koss ,2006)

(P. Murugan ,2009) and (Leopold G. Koss, 2006)

Figure 8 : Cluster of cells with enlarged, variably-sized round or

oval nuclei with prominent or macronucleoli. Smear background is clean.

Figure 9 : Cells in papillary configurations and

Psammaomatus calcifications ( psammoma bodies )

REFERENCES

ASPECT ECAC EMAC EUAC

Cell Single & columnar Cluster & cuboidal Cluster & papillary

Diathesis Necrotic watery Clean

cell arrangement 2D 3D 3D

Nucleus Enlarged , variable in size

Round-oval

Enlarged , variable in size

Round-oval

Enlarged , variable in size

Round-oval

Cytoplasm Abundant cytoplasm and

finely vacuolated

Scant or abundant vacuolated cytoplasm

Scanty cytoplasm

Nucleoli Prominent nucleoli Small to prominent nucleoli

Prominentnucleoli

Others Irregular chromatin distributed

Loss of polarityIntracytoplasmic neutrophils seen

Psammoma bodies seen

(Solomon & Nayar,2004)

(Solomon & Nayar ,2004)

(Solomon & Nayar, 2004) and ( Leopold G. Koss ,2006)

Journal :• Kondo, T., Hashi, A., Murata, S.-i., & Nakazawa, T. (2005). Endocervical adenocarcinomas associated with lobular endocervical glandular hyperplasia: a report of four cases with histochemical and immunohistochemical analyses. Modern Pathology , 1199–1210.• P.Murugan, N. S. (2009). Malignant Mixed Müllerian Tumor in Ascitic Fluid: A Case Report with a Brief Review of Literature. The internet Journal of Pathology .• RM, D. (2000). Hyperchromatic crowded group : Pitfalls in pap smear Diagnosis . American Journal Clinical Pathology , 36-43.• Eduardo Lazcano-Ponce, M. D.-M.-A. (2003). Recommendations for cervical cancer screening programs in developing countries. The need for equity and technological development. salud pública de méxico , 449-462.• Edward B. Stelow, M. (2005). Endometrial Cells and the Papanicolaou Test. American Society for Clinical Pathology , 829-831.

Books :• Leopold G. Koss, M. R. (2006). Koss' diagnostic cytology and its histopathologic bases. Lippincott Williams & Wilkins.• Solomon, D., & Nayar, R. (2004). The Bethesda System For Reporting Cervical Cytology. Springer, 141-153.

Articles :• Monk, D. B. (2009, December 2). Pathogenesis of Cervical Adenocarcinoma. Women's Health and Education Center (WHEC) .• Ministry of Health, 2002. National Cancer Registry Report

Website :•Ujian Saringan untuk Kanser Sistem Pembiakan - Kanser Servik. (2008, April 28). Retrieved september 3, 2010, from My Health For life: http://portal.imateradigital.com/myhealth/bm/dewasa_content.jsp?lang=dewasa&storymaster=0&storyid=1154958496810&substoryid=1130730545609#

Table 1 : Comparison between types of adenocarcinoma

*ECAC= Endocervical Adenocarcinoma EMAC= Endometrial Adenocarcinoma EUAC= Extrauterine Adenocarcinoma

Figure 8 :The women with adenocarcinoma must immediately be referred to

a GynecologicalOncology Clinic.

(Eduardo Lazcano-Ponce, 2003)

NORMAL GLANDULAR CELLS

Figure 2 : Endometrial cells, 3D aggregates of crowded cells

scanty cytoplasm and nuclear hyperchromatin

Figure 1 : Endocervical cells, Honeycomb structure , contain of nuclei , and distinct cytoplasmic

border

(Solomon & Nayar,2004) and (Edward B. Stelow, 2005)

(R M, 2000) and (Solomon & Nayar ,2004)