Pathologic findings in women with atypical glandular cells on Pap test

Introduction: It has been shown that a significant subset of atypical glandular cells (AGC) indicates underlying malignancies. Therefore, it is imperative to recognize, diagnose, and treat these lesions early. We evaluated the clinical significance of AGC on cervical cytology in our hospital.

Materials and methods: A total of 376 consecutive Pap tests with a diagnosis of AGC between January 2005 and January 2011 at a tertiary community hospital were reviewed and correlated with concurrent or follow-up histopathology.

Results: Over a 6-year period 376 (0.23%) Pap tests were reported as AGC. Histopathology was available in 223 cases. Atypical hyperplasia, dysplasia, or malignant lesion was found in 128 (57.4%) cases. Of these, 80 (62.5%) were glandular lesions. In women younger than 48 years benign lesions (52.9%) were more common. Women who were 48 years and older were more likely to have a malignant glandular lesion (56 out of 73, 76.7%) compared with women under 48 years, who were more likely to have a malignant squamous lesion (31 out of 55, 56.4%).This difference was statistically significant (P = 0.002). Malignant lesion was seen in 58 (26%) of the women. Endometrial carcinoma (30 cases) was the most common malignancy-51.7% of the malignant lesions and 13.4% overall. Chronic cervicitis and endometritis were the most common non-malignant findings.

Conclusion: AGC on Pap test may be the initial manifestation of a wide range of cervical pathologies. Because many AGC diagnoses did not have a histopathological follow-up, clinicans should be more diligent at having patients follow up, especially in peri- and post-menopausal women.