Atypical glandular cells review

Atypical glandular cells on a Pap test are rare, but guidelines treat them as findings that need prompt workup rather than repeat screening alone. (asccp.org) A Pap test looks at cells shed from the cervix, and glandular cells come from the cervical canal and the uterine lining rather than the outer cervical surface. The American College of Obstetricians and Gynecologists says an atypical glandular cells result raises concern for precancer or cancer in those glandular cells. (acog.org) The American Society for Colposcopy and Cervical Pathology says women with atypical glandular cells usually need human papillomavirus testing, colposcopy, and endocervical sampling, and many also need endometrial biopsy. Its patient resource says 10% to 40% have high-grade dysplasia or worse. (asccp.org) That broader workup reflects where these cells can come from. ASCCP’s guidance says glandular abnormalities can be linked to benign polyps, but also to cancers of the cervix, endometrium, ovary, or fallopian tube. (asccp.org) The 2019 ASCCP consensus guidelines shifted abnormal screening management toward a risk-based model built on current test results, prior screening, biopsy history, age, and factors such as immunosuppression. ACOG endorsed that framework in an October 2020 practice advisory. (pmc.ncbi.nlm.nih.gov) (acog.org) For atypical glandular cells, the practical algorithm remains more aggressive than for many squamous abnormalities. Current summaries of the ASCCP guidance say all AGC subcategories except atypical endometrial cells go to colposcopy with endocervical sampling regardless of human papillomavirus result, with endometrial sampling added at age 35 or older or earlier when endometrial cancer risk factors are present. (pathologyoutlines.com) Atypical endometrial cells are handled a little differently. ASCCP-based summaries say the preferred first step is endometrial and endocervical sampling, with colposcopy acceptable at the initial visit. (guidelinecentral.com) Recent follow-up studies help explain why pathologists and clinicians keep treating AGC as a high-attention result even though it appears in fewer than 1% of Pap smears. In a 2024 Milan series covering 239 women diagnosed from 2012 to 2022, 12.1% had preinvasive cervical neoplasia and 10.9% had invasive cervical or endometrial disease. (pmc.ncbi.nlm.nih.gov) That same study found menopause, older age, and multiparity were associated with endometrial cancer, while 61% of the 190 women who completed both colposcopy and endometrial assessment had no pathologic finding. The authors concluded that AGC can point to a wide spectrum of disease and warrants both cervical and endometrial evaluation. (pmc.ncbi.nlm.nih.gov) The reporting challenge is that AGC is a microscope category, not a diagnosis. It means the cells look more abnormal than a benign repair change, but not definitively like adenocarcinoma, which is why the follow-up pathway is designed to find the small but consequential lesions that cytology alone cannot localize. (pmc.ncbi.nlm.nih.gov) (pathologyoutlines.com) That is why review threads on AGC keep circling back to the same point: one Pap label can represent a cervical polyp, adenocarcinoma in situ, or an endometrial cancer higher in the tract, and the workup has to look in more than one place. (asccp.org)