title: Identification of atypical glandular cells in pap smears: is it a hit and miss scenario?.
abstract: OBJECTIVE
  Glandular cell abnormality (GCA) in Pap smears is uncommon. Detection is important as the possibility of underlying high-grade lesions is greater in this entity than in atypical squamous cells of undetermined significance. This study was undertaken with an aim to correlate GCA cases with histology, scrutinize its mimics and identify cytologic features to segregate significant lesions from benign.
  
  
  METHODS
  A total of 22,618 conventional Pap smears were retrospectively analyzed. In all, 74 GCA cases were identified, correlated with histology and reevaluated using parameters based on architectural pattern, cellular features and background.
  
  
  RESULTS
  This study revealed 15 false positives. On review, 11 cases [1 adenocarcinoma, 5 atypical glandular cells (AGC), not otherwise specified, 5 AGC, favor neoplasia (FN)] were recategorized as reactive. Of 9 cases reported as cervical intraepithelial neoplasia on histology, cytodiagnosis in 5 was revised from AGC-FN to high-grade squamous intraepithelial lesion involving glands. Initial overall cytohistology concordance was 79.7%. Reevaluation of the smears, based on stringent cytomorphological criteria, enhanced overall agreement to 94.59%.
  
  
  CONCLUSIONS
  A diagnosis of AGC has considerable clinical implications. Dissociated atypical cells, nuclear membrane, architecture and chromatin pattern are the key distinguishing features between neoplastic and benign lesions.
authors.affiliation: Department of Cytopathology, Tata Memorial Hospital, Mumbai, India. dulhan@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Ajit
authors.forename: S
authors.initials: S
authors.lastname: Gavas
authors.forename: S
authors.initials: S
authors.lastname: Joseph
authors.forename: B
authors.initials: B
authors.lastname: Rekhi
authors.forename: K
authors.initials: K
authors.lastname: Deodhar
authors.forename: S
authors.initials: S
authors.lastname: Kane
mesh_terms: D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D002578:Uterine Cervical Dysplasia / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears