The discrimination of hyperchromatic crowded cell groups hccgs in cervical cytology is a difficult and error. Sep 16, 2019 cytomorphological features of hyperchromatic crowded groups in liquidbased cervicovaginal cytology. Evaluation and significance of hyperchromatic crowded groups hcg in liquidbased paps. Recognize the key features of normal and abnormal findings of cervical cytology. Hyperchromatic crowded groups in cervical cytologydiffering. Cytomorphological features of hyperchromatic crowded groups. Many groups of cells showed minimal atypia and features identical to those described earlier for vgc.
Cell block preparation by inverted filter sedimentation is. Conventional cytology may be inadequate lbc may see collections of altered blood. These groups are frequently encountered in liquidbased cytology lbc samples and can be difficult to identify as a specific cell type. Hyperchromatic crowded groups in cervical cytology differing appearances and interpretations in conventional and thinprep preparations. Hyperchromatic crowded groups pitfalls in pap smear. Pathology outlines squamous cell carcinoma and variants. Case johns hopkins cytopathology unknown conference. The nuclei may be little larger than lymphocytes, polymorphs or normal intermediate squamous cell nuclei the groups may be crowded with no definition to the cytoplasmic cell borders. The cells showed high nuclearcytoplasmic ratios, hyperchromatic nuclei with. Cytology of cervical precancerous lesions obgyn key. May 14, 20 hyperchromatic crowded groups hcgs in the pap test. Image analysis of hyperchromatic crowded cell groups in surepath.
The hyperchromatic crowded groups cytologic diagnosis of. Hyperchromatic crowded groups pitfalls in pap smear diagnosis. Certain principles of reporting cytology that were intended in. Demay noted that although hyperchromatic crowded groups are usually benign and include such entities as endometrial cells and severe atrophy. Cervical cytology screening is a complex and demanding procedure. The cells of hsil occur in two main patterns, which include syncytiallike aggregates hyperchromatic crowded groups and discrete single cells fig. Hyperchromatic crowded groups hyperchromasia, variation in size and shape nuclear enlargement, increase in nc ratios. Cap webinar to use the pdf presentation solely for educational. Tripath imaging 2002 atlas of gynecologic cytology.
Interpretation pitfalls and malignant mimics in cervical cytology. Learn the interpretative categories of the bethesda system for reporting cervical cytology. Atypical glandular cells of undetermined significance in cervical smears after conization. Comparison of diagnostic cytomorphology of atypical. Pattern of cervical biopsy results in cases with cervical. Pdf should lsil with asch lsilh in cervical smears be.
Vinod shidham department of pathology wayne state university. The bethesda system provides a framework for consistent interlaboratory terminology for the reporting of cervicovaginal cytology specimens it was first conceived in 1988 with updates in 1991, 2001 and 2014 jama 2002. Although various studies in western countries established. Interpretation pitfalls and malignant mimics in cervical. Hyperchromatic crowded groups hcgs, also known as microbiopsies are defined as threedimensional aggregates of crowded cells with.
Hyperchromatic crowded groups hyperchromasia, variation in size and shape nuclear enlargement, increase in nc ratios fine or coarsely granular, evenly distributed chromatin. Hyperchromatic crowded groups hcg, a term first introduced into the cytology literature by demay in 1995, are commonly observed in pap. The objective of cervical screening is detection and identification of abnormal cells from the uterine cervix and occasionally other parts of the gynaecological. Terminology in cervical cytology current diagnostic. Cervical intraepithelial neoplasia in postmenopausal women. These are 3d groups of cells that appear dark and are difficult to assess. Syncytial aggregates hyperchromatic crowded groups flattening at the edges of the cell cluster, whorling of cells in the center, and. Cytology of cervical intraepithelial glandular lesions. The practice of gynecologic cytology requires that highgrade squamous intraepithelial lesion hsil be precisely recognized. Cytology laboratory from jan 2011 to june 20 30 months were retrieved for the study. Comparison of diagnostic cytomorphology of atypical squamous. Nhscsp 2006 thinprep pap test morphology reference atlas. The bscc did not propose any major changes but moved closer to the twotier bethesda system for reporting precancerous changes as highgrade and lowgrade.
Normal cells identified from the vagina, cervix, transformation zone, endocervix. Mar 01, 2021 the cells of hsil occur in two main patterns, which include syncytiallike aggregates hyperchromatic crowded groups and discrete single cells fig. A retrospective study on interobserver variation of pap. Ovaninraki et al cervical intraepithelial glandular lesions cytology, coll. In this study, we specifically defined hcg as dark crowded cell groups with more than 15 cells which can be identified at 10. Evaluation and significance of hyperchromatic crowded groups. In conventional smears, these groups are more likely to be labeled as a squamous lesion, owing to their elongate and large nuclei. Irregular margin of the cluster and the loss of polarity of the peripheral cells are the features of hcg produced by dysplastic cells. Nhs cervical screening programme cervical cytopathology atlas.
In this regard, hyperchromatic crowded groups are known to be difficult to classify in conventional gynecologic cytology, but whether this is true in thinprep specimens is uncertain. Evaluation and significance of hyperchromatic crowded. Hyperchromatic crowded cell groups in gynaecological liquid. Hyperchromatic crowded groups hcg, a term first introduced into the cytology literature by demay in 1995, are commonly observed in pap tests and may rarely be associated with serious but.
The advantages of incorporating liquidbased cytology. In this regard, hyperchromatic crowded groups are known to be difficult to classify in conventional gynecologic cytology, but whether this. Cytologic features of villoglandular adenocarcinoma of the. Jan 22, 2007 hyperchromatic crowded groups hcg, a term first introduced into the cytology literature by demay in 1995, are commonly observed in pap tests and may rarely be associated with serious but. Cureus comparison of liquidbased cytology and conventional. College of american pathologists practical guide to gynecologic. True glandular precursors or adenocarcinoma present in only. Squamous cells with binucleation and nuclear enlargement. Triage of study patients with hpvnegative asch results to routine hpv and cytology cotesting at 1 year was a safe followup option 11. Shidham vb, mehrotra r, varsegi g, damore kl, hunt b, narayan r. They may be composed of normal or abnormal cells and may be squamous or glandular. There has been a tremendous decline in the morbidity and mortality of cervical carcinoma due to the successful screening with cervical cytology smear pap smear with early treatment of precancerous lesions.
In contrast to the smears from primary pscc, only rare sheets of cells were figure 7. Hyperchromatic crowded groups of cells are a source of dif. The hyperchromatic crowded group hcg may be noted in both benign and dysplastic cells figure 1. This article provides an illustrated personal view of the british society for clinical cytology s bscc proposal to modify their terminology for reporting cervical cytology. While the classic features of dyskaryosis are of undoubted value, the contribution of size, shape and colour intensity of hccgs is less certain. The hyperchromatic crowded groupscytologic diagnosis of. The heca cohort consisted of 63 uterine lesions 91. Hyperchromatic crowded groups hcgs, also known as microbiopsies are defined as threedimensional aggregates of crowded cells with hyperchromatic nuclei 1. Image analysis of hyperchromatic crowded cell groups in. These groups are frequently encountered in liquidbased cytology lbc samples and can be diff. This article aims to describe and illustrate cell changes seen in cervical smears and liquidbased preparations using the british society for clinical cytology s terminology used in the uk and the modifications proposed in 2002, which have yet to be adopted by the national health service cervical screening programme nhscsp, and to relate this terminology to other systems used. Cytologic features of papillary serous adenocarcinoma of. They are commonly found in liquidbased cytology lbc samplesin almost 80% according to one study 2 and are easily detected at lowpower magnification.
Detecting and interpreting glandular lesions in cervical. The term hyperchromatic crowded groups hcg was introduced into the cytology literature in demays 1995 first edition of the art and science of cytopathology. Followup of patients with hpvnegative asch results yielded very low rates of detectible cin23 1. Cervical carcinoma is the fourth most frequent cancer in women and represents 6. Quality control in cervical cancer screening in slovenia. Hyperchromatic crowded cell groups in gynaecological liquidbased. Hcgs usually represent benign entities such as endometrial cells, syncytial aggregates in severe atrophy, or fragments of endocervical tissue, the. Specimen adequacy modified from the bethesda system for reporting cervical cytology. Pdf should lsil with asch lsilh in cervical smears be an. The interpretation of atypical glandular cells agc should be qualified, if possible, to indicate whether the cells are of endocervical or endometrial origin. The bethesda system for reporting cervical cytology. The bethesda system for reporting cervical cytology, 3rd edition, 2015. Hyperchromatic crowded groups in cervical cytology. Hyperchromatic crowded groups hcgs in the pap test.
Hyperchromaticcrowded groups hcg in pap smears cytojournal. The interpretation of atypical glandular cells agc should be qualified, if possible, to indicate whether the. Objective hyperchromatic crowded groups hcg, a term first introduced into the cytology literature by demay in 1995, are commonly observed in pap tests and may rarely be associated with serious but difficult to interpret lesions. Squamous cell atypia two cases and atypical squamous metaplasia three cases in the lbps were initially interpreted as reactive cellular changes in the cor. Atypical squamous cells asc of undetermined significance ascus. Nov 10, 2000 in the group of four typical endocervical adenocarcinomas with focal papillary areas, a mixed cytologic appearance was evident. Correct diagnosis depends on accurate interpretation of cells, including dense clusters known as hyperchromatic crowded cell groups hccg. Cytomorphological features of hyperchromatic crowded groups in. Cytologic features differentiating them from adenocarcinoma in situ. Cellular morphology, hyperchromatic crowded groups. Pap smears were selected and examined to determine the cervical changes and graded using the bethesda system of reporting cervicovaginal cytology first by the investigator then. Hyperchromatic crowded cell groups in gynaecological liquidbased cytology samples. Be familiar with the common types of high risk hpv associated with cervical cancer.
Correct diagnosis depends on accurate interpretation of cells, including dense clusters known as hyperchromatic crowded cell groups. Differing appearances and interpretations in conventional and thinprep preparationsrenshaw et al 6. Cytomorphological features of hyperchromatic crowded. The hyperchromatic crowded groups cytologic diagnosis of glandular lesions. Pap smear showed hcg with focal pseudorosette formation. Hyperchromatic crowded cell groups are known to be at risk for a false negative diagnosis in conventional smears and liquidbased preparations demay 2000. Cervical cytology preparations may show hcg with atypical features suggestive of malignancy including sheets and strips with nuclear crowding, overlap andor pseudostratification, rare cell groups with rosettes gland formations or feathering, enlarged and elongated nuclei with hyperchromasia, coarse chromatin with heterogeneity, occasional. The single cell pattern poses a particular diagnostic challenge in this scenario because it overlaps with the single cell pattern that can be seen with the small dark cells associated with. The cells were arranged in small pseudopapillary groups and in tight cell balls. Potential reflex testing on specially prepared cell blocks from residual liquidbased cytology specimens. Be familiar with the recommended cervical cancer screening guidelines by asccp. Terminology in cervical cytology current diagnostic pathology. Hyperchromatic crowded cell groups in gynaecological.
In lipomatous hypertrophy of the interatrial septum, hypertrophied cardiac myocytes with nuclei exhibiting variation in. Introduction after the introduction of cervical cancer screening program with cervical cytology, a marked decline in deaths secondary to cervical cancer was observed in developed countries. However, crowded groups of cells with a feathered appearance at their periphery were common fig. Pdf evaluation and significance of hyperchromatic crowded.
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