Introduction: Gastric-type mucinous carcinoma (GAS) of the uterine cervix is an adenocarcinoma subtype with a gastric phenotype that poses diagnostic pitfalls in cervical screening cytology because of its blunt morphologic atypia and the limited utility of human papillomavirus testing and ancillary immunochemical staining. Despite the recent widespread uptake of liquid-based cytology (LBC) systems, the cytomorphological features of GAS in LBC samples and the differential features between GAS and usual-type endocervical adenocarcinoma (UEA) remain unclear. Methods: Eight GAS cases, all of which were surgically treated following histological confirmation, were examined. Direct Papanicolaou-stained smears and LBC samples were reviewed and compared with 10 UEA cases as controls. Featured cytomorphological findings were as follows: background (mucinous, inflammatory, or necrotic), cell crowding (size of neoplastic cell clusters), cytoplasm (golden mucin and cell border), and nuclei (nuclear chromatin and nucleoli). Results: Of 18 adenocarcinomas, 16 were detected against a non-mucinous background in LBC samples, most of which were accompanied by mild to moderate inflammation. Clusters comprising #x3e;300 neoplastic cells were identified in both GAS and UEA in conventional smears (CSs), while no LBC samples harboured clusters as large as these. Cell borders of GAS were more distinct than those of UEA in CSs (p #x3c; 0.001), although fewer populations of neoplastic clusters revealed distinct cell borders in both GAS and UEA in LBC samples. Three of 8 and 2 of 8 GAS cases had golden mucin in CSs and in LBC samples, respectively, which was not detected in UEA at all. Nucleoli against fine nuclear chromatin were more pronounced in GAS than in UEA on CS (p = 0.03), although the difference between GAS and UEA was not apparent in LBC samples. Discussion/Conclusion: This study demonstrated that the diagnostic clues to detect GAS using the conventional approach, namely distinct cell borders and prominent nucleoli, are not useful for excluding UEA in LBC samples. Conventional cervical smears may indicate a diagnosis of GAS; however, specific high-risk HPV detection approaches, such as HPV test or immunocytochemical p16/Ki-67 dual staining, are desirable to differentiate GAS from UEA in the setting of LBC with ambiguous cytomorphological features.
Acta Cytologica

中文翻译：

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与液基宫颈细胞学鉴定的细胞形态学特征相比，常规直接涂片产生胃型黏液癌的诊断指标

简介：胃型子宫颈粘液癌（GAS）是一种具有胃表型的腺癌亚型，由于其钝性形态学非典型性以及人类乳头瘤病毒检测和辅助免疫化学染色的实用性有限，因此在宫颈筛查细胞学中具有诊断缺陷。尽管最近广泛吸收了基于液体的细胞学（LBC）系统，但LBC样品中GAS的细胞形态学特征以及GAS与常规型宫颈癌（UEA）之间的区别特征仍不清楚。方法：检查了8例GAS病例，所有这些病例均在组织学确认后进行了手术治疗。审查了直接巴氏染色的涂片和LBC样本，并与10例UEA病例作对照。特色细胞形态学发现如下：背景（粘液性，炎性或坏死性），细胞拥挤（瘤细胞簇大小），细胞质（金黄粘蛋白和细胞边界）和细胞核（核染色质和核仁）。结果：在18例腺癌中，有16例在LBC样本中检测到非粘液性背景，其中大多数伴有轻度至中度炎症。在常规涂片（CS）中，在GAS和UEA中都鉴定出包含＃x3e; 300个赘生性细胞的簇，而没有LBC样本具有如此大的簇。在CS中，GAS的细胞边界比UEA的细胞边界更为明显（p＃x3c； 0.001），尽管在LBC样品中，GAS和UEA的肿瘤簇揭示出明显的细胞边界。8例GAS病例中的3例和2例中有2例在CSs和LBC样品中都有金色粘蛋白，而在UEA中根本没有检测到。在CS中，抗细核染色质的核仁比UEA更明显（p= 0.03），尽管在LBC样本中GAS和UEA之间的差异并不明显。讨论/结论：这项研究表明，使用常规方法检测GAS的诊断线索，即明显的细胞边界和突出的核仁，对于排除LBC样品中的UEA没有用。常规宫颈涂片可能提示诊断为GAS。但是，需要特殊的高危HPV检测方法，例如HPV检测或免疫细胞化学p16 / Ki-67双重染色，以在LBC的情况下将GAS与UEA区别开来，并具有模糊的细胞形态学特征。
细胞学学报