THE BETHESDA SYSTEM & EVALUATION OF A PAP SMEAR IN GLANDULAR

CARCINOMA
Lailatul Jalilah, M. R. , Adibah, A. R. , Mohd Hairi, A. , Siti Mariam, M. , Siti Najihah, M., Norhalifah Hanim, K., Siti Amalina, M. R.
BACHELOR OF MEDICAL LAB TECHNOLOGY (HONS) , FACULTY OF HEALTH SCIENCE , UNIVERSITI TEKNOLOGI MARA , PUNCAK ALAM CAMPUS , 42300 BANDAR PUNCAK ALAM, SELANGOR.

IINTRODUCTION CONCLUSION
 Adenocarcinoma is a cervical cancer that originates in the
mucus-producing cells of the inner or endocervix, near the body of ASPECT ECAC EMAC EUAC
the uterus.
Cell Single & columnar Cluster & cuboidal Cluster & papillary
 Cervical adenocarcinoma is most common in women over 45
7.9% all cancer cases admitted to government hospitals are Diathesis Necrotic watery Clean
derived from cervical cancer. cell arrangement 2D 3D 3D

• Common method of collection: Nucleus Enlarged , variable Enlarged , variable Enlarged , variable
PAP Smear Figure 7 : Showing a cluster of adenocarcinoma with glandular
in size in size in size
Round-oval Round-oval Round-oval
pattern with cells displaying high N: C ratio, vesicular nuclei,
• Types of Glandular adenocarcinoma: prominent nucleoli and scanty to moderate cytoplasm. Cytoplasm Abundant Scant or abundant Scanty cytoplasm
cytoplasm and vacuolated
 Endocervical adenocarcinoma Figure 4 : nuclear enlargement, size of nuclei is variable, prominent finely vacuolated cytoplasm
macronucleoli , irregular chromatin distribution , nuclear membrane (P. Murugan ,2009) and (Leopold G. Koss, 2006)
 Endometrial adenocarcinoma Nucleoli Prominent nucleoli Small to prominent Prominent
 Extrauterine adenocarcinoma irregularities, scanty cytoplasm.
nucleoli nucleoli
(Solomon & Nayar,2004) and (Edward B. Stelow, 2005) (Kondo, Hashi, Murata, & Nakazawa, ,2005) and (Solomon & Nayar ,2004) EXTRAUTERINE ADENOCARCINOMA
Others Irregular chromatin Loss of polarity Psammoma
NORMAL GLANDULAR CELLS distributed Intracytoplasmic bodies seen
neutrophils seen
Table 1 : Comparison between types of adenocarcinoma

*ECAC= Endocervical Adenocarcinoma

EMAC= Endometrial Adenocarcinoma
EUAC= Extrauterine Adenocarcinoma

(Solomon & Nayar, 2004) and ( Leopold G. Koss ,2006)

REFERENCES

Figure 1 : Endocervical cells, Figure 2 : Endometrial cells, 3D Journal :

Honeycomb structure , contain of
nuclei , and distinct cytoplasmic
border
(R M, 2000) and (Solomon & Nayar ,2004)
ENDOCERVICAL ADENOCARCINOMA
Figure 5 : cells in cluster , prominent macronucleoli seen, large • Kondo, T., Hashi, A., Murata, S.-i., & Nakazawa, T. (2005). Endocervical adenocarcinomas
aggregates of crowded cells Figure 8 : Cluster of cells with Figure 9 : Cells in papillary
overlapping of nuclei and tumor diathesis may be less prominent. associated with lobular endocervical glandular hyperplasia: a report of four cases with
scanty cytoplasm and nuclear enlarged, variably-sized round or configurations and histochemical and immunohistochemical analyses. Modern Pathology , 1199–1210.
hyperchromatin oval nuclei with prominent or Psammaomatus calcifications • P.Murugan, N. S. (2009). Malignant Mixed Müllerian Tumor in Ascitic Fluid: A Case Report
(Solomon & Nayar,2004)
macronucleoli. Smear ( psammoma bodies ) with a Brief Review of Literature. The internet Journal of Pathology .
background is clean. • RM, D. (2000). Hyperchromatic crowded group : Pitfalls in pap smear Diagnosis . American
ENDOMETRIAL ADENOCARCINOMA Journal Clinical Pathology , 36-43.
(Solomon & Nayar ,2004) • Eduardo Lazcano-Ponce, M. D.-M.-A. (2003). Recommendations for cervical cancer
screening programs in developing countries. The need for equity and technological
ALGORITHM development. salud pública de méxico , 449-462.
• Edward B. Stelow, M. (2005). Endometrial Cells and the Papanicolaou Test. American
Society for Clinical Pathology , 829-831.

Books :
• Leopold G. Koss, M. R. (2006). Koss' diagnostic cytology and its histopathologic bases.
Lippincott Williams & Wilkins.
• Solomon, D., & Nayar, R. (2004). The Bethesda System For Reporting Cervical Cytology.
Figure 8 :The women with adenocarcinoma must Springer, 141-153.
immediately be referred to
Articles :
a Gynecological
• Monk, D. B. (2009, December 2). Pathogenesis of Cervical Adenocarcinoma. Women's
Oncology Clinic. Health and Education Center (WHEC) .
Figure 6 : Nuclear abnormalities, including nuclear enlargement or • Ministry of Health, 2002. National Cancer Registry Report
nucleoli, moderate hyperchromasia, loss of polarity and a watery
Website :
diathesis are clues to the diagnosis •Ujian Saringan untuk Kanser Sistem Pembiakan - Kanser Servik. (2008, April 28).
Figure 3 : nuclear enlargement , pleomorphic nuclei seen, irregular (Eduardo Lazcano-Ponce, 2003) Retrieved september 3, 2010, from My Health For life:
chromatin distribution and necrotic background of smear (R M ,2000) and ( Leopold G. Koss ,2006) http://portal.imateradigital.com/myhealth/bm/dewasa_content.jsp?
(R M, 2000) and (Solomon & Nayar ,2004) lang=dewasa&storymaster=0&storyid=1154958496810&substoryid=1130730545609#

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