Clinicopathological Characteristics of Ciliated Change of Endocervical Gland: A Mimic of “Endocervical Glandular Dysplasia”
Fumi Kawakami, Yoshiki Mikami, Yasuhiko Ebina, Hideto Yamada, Tomoo Itoh. Kobe University Hospital, Kobe, Hyogo, Japan; Kyoto University Hospital, Kyoto, Japan
Background: A variety of benign endocervical glandular lesions or changes can be misinterpreted as “endocervical glandular dysplasia”, of which ciliated change (CC) is considered to be a representative because of nuclear stratification. However, clinicopathologic characteristics of CC have not been well described.
Design: A total of 455 cases were retrieved from the file to review HE slides of uterine cervix without significant lesions, were included in the study. Clinical records were reviewed, and presence or absence of CC and coexisting tuboendometrioid metaplasia, and if exists its distribution, were evaluated. In addition, nuclear features with columnar epithelium with CC were evaluated in selected 100 cases and compared with 6 cases of adenocarcinoma in situ (AIS). Specifically, degree of nuclear stratification and heterogeneity in nuclear size and nuclear staining pattern were scored with a 3-tier scale. immunohistochemistry for p16, vimentin, and Ki-67 was performed to characterize CC.
Results: Among the 455 cases, 383 (84.2%) showed CC, of which 228 cases (59.5%) showed diffuse and 155 (40.5%) showed focal distribution. CCs were identified equally in transformation zone and endocervical canal. Presence or absence of CC was not correlated with age, menstruation status, and tuboendometrioid metaplasia. Reproductive history was available in 441 cases. CCs were significantly more common in nulligravida women (99/106, 93.4%) compared with multi gravida women (273/335, 81.5%) (p=0.003). Significant nuclear stratification (score 1, n=5; score 2, n=41; score 3, n=54) and mild to moderate nuclear enlargement and heterogeneity in nuclear size (score 1, n=25; score 2, n=64; score 3, n=11) were common in CC, but hyperchromatism was minimal (score 1, n=69; score 2, n=31; score 3, n=0) as seen in cases of AIS (score 1 and 2, n=0; score 3, n=6). Mitotic figures were only rarely seen. Immunohistochemically, CCs were delineated as thin rod- or pyramid-shaped cells tapering from apical side with cytoplasmic staining for p16 and vimentin, intervened by non-ciliated cells, resulting in “keyboard appearance”. The Ki-67 labeling index was less than 5% (mean, 1.5; range, 0.1-4.2).
Conclusions: The CC is commonly seen in uterine cervix, and has a relation with reproductive history. Occasionally it shows significant nuclear stratification and enlargement, and thus can be interpreted as “glandular dysplasia”. However, hyperchromatism is minimal, mitosis is rare, and Ki-67 index is low. Vimentin and p16 staining reveals “keyboard appearance”.
Category: Gynecologic & Obstetrics
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 183, Wednesday Afternoon