Agc y adeno
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El documento describe diferentes tipos de anormalidades epiteliales glandulares y adenocarcinoma en el cuello uterino, incluyendo células glandulares atípicas, adenocarcinoma in situ y adenocarcinoma invasor endocervical y endometrial. Explica los criterios morfológicos para diagnosticar cada condición y cómo se ven bajo microscopio de luz e inmersión. También discute el manejo clínico recomendado para adenocarcinoma in situ.
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Agc y adeno
- 1. AGC Y ADENOCARCINOMA DRA LUISA MARIA ROJAS JARAMILLO DIPLOMADO EN COLPOSCOPIA INSTITUTO NACIONAL DE PERINATOLOGÍA
- 2. ANORMALIDADES DE CÉLULAS EPITELIALES • Células glandulares atípicas • Células endometriales (NOS) • Células endocervicales (NOS, en faor de una neoplasia) • Células glandulares (NOS, en favor de una neoplasia) • Adenocarcinoma in situ (endocervical) (AIS) • Adenocarcinoma invasor • Endocervical • Endometrial Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 3. INTRODUCCIÓN • La interpretación de células atípicas – endocervical, endometrial o glandular – un nivel elevado de riesgo • El término (AGC-US) ya no es utilizada • Las células glandulares atípicas deben clasificarse de acuerdo al origen. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 4. CÉLULAS ENDOCERVICALES ATÍPICAS • Definición: • Presenta atipia nuclear que excede los cambios reactivo o reparación pero carece de características inequívocas de adenocarcinoma endocervical in situ o invasor. • Criterios (no clasificado en otra parte, NOS) • Células en lámina o tiras, conglomeradas, superposición nuclear y/o pseudoestratificación. • Agrandamiento nuclear (3-5 veces mayor nucleo endocervical normal) • Variación forma y tamaño nuclear • Moderada hipercromasia nuclear • Cromatina irregular moderada • Indice nucleo/citoplasma elevado. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 5. CÉLULAS ENDOCERVICALES ATÍPICAS (CC) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 6. CÉLULAS ENDOCERVICALES ATÍPICAS (BL) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 7. CÉLULAS ENDOCERVICALES ATÍPICAS (CC) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 8. • Definición • Morfología celular de forma cuantitativa o cualitativa no cumple con criterios para adenocarcinoma. • Criterios (en favor a neoplasia) • Células en lámina o tiras, conglomeradas, superposición nuclear y/o pseudoestratificación. • Grupos de células raras con rosetas • Nucleo alargado con hipercromasia • Cromatina gruesa • Mitosis ocasional • Indice nucleo citoplasma elevado • Bordes mal definidos. CÉLULAS ENDOCERVICALES ATÍPICAS Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 9. CÉLULAS ENDOCERVICALES ATÍPICAS (CC) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 10. CÉLULAS ENDOCERVICALES ATÍPICAS (CC) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 11. CÉLULAS ENDOMETRIALES ATÍPICAS • Para diferenciar de células benignas de atípicas se basa principalmente en el crecimiento nuclear. • Generalmente no calificadas como ”en favor a neoplasia” • Se pueden agregar comentarios / historial clínico (DIU, Pólipo) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 12. • Grupos pequeños (5-10 células) • Nucleo ligeramente alargado en comparación con células endometriales normales • Hipercromasia moderada • Cromatina heterogenea • Nucleolos pequeños ocasionales • Citoplasma escaso vacuolado ocasional • Bordes celulares mal definidos. CÉLULAS ENDOMETRIALES ATÍPICAS Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 13. CÉLULAS ENDOMETRIALES ATÍPICAS (CC) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 14. CÉLULAS ENDOMETRIALES ATÍPICAS (CBL) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 15. MANEJO DE AGC Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 16. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 17. ADENOCARCINOMA
- 18. ADENOCARCINOMA ENDOCERVICAL IN SITU • Lesión endocervical glandular de alto grado • Caracterizado por alargamiento nuclear, hipercromasia, cromatina anormal, pseudoestratificacion y actividad mitótica. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 19. ADENOCARCINOMA ENDOCERVICAL IN SITU Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 20. ADENOCARCINOMA ENDOCERVICAL IN SITU Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 21. ADENOCARCINOMA ENDOCERVICAL IN SITU Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 22. • En preparaciones en base líquida • Facil encontrar células individuales intactas • Grupos conglomerados hipercromaticos son mas pequeños, densos, tridimensional, márgenes mas suaves • Tiras de células pseudoestratificadas, con frecuencia en forma de “cola de pájaro”. • Cromatina nuclear puede ser mas gruesa o granular fino • Se observa con mayor facilidad los nucléolos ADENOCARCINOMA ENDOCERVICAL IN SITU Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 23. MANEJO DEL ADENOCARCINOMA IN SITU • Colposcopia • Biopsia endocervical Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 25. ADENOCARCINOMA INVASOR • Criterios • Abundantes células anormales, típicamente columnares • Células individuales, grupos en racimos, agregados sincitiales • Núcleo pleomórfico alargado, distribución de la cromatina irregular, irregularidad de membrana nuclear. • Macronucleolos. • Citoplasma vacuolado. • Diatesis tumoral necrótica. • Celulas escamosas anormales pueden estar presentes, representando coexistencia o el componente escamoso de adenocarcinoma demostrando diferenciación escamosa parcial. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 26. ADENOCARCINOMA Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 27. ADENOCARCINOMA INVASOR • En preparaciones de base liquida • Grupos celulares tienden a ser densos, esféricos y tridimensionales. Los nucleos de la porción central suelen estar oscurecidos. • Celulas aisladas anormales • La cromatina es mas vesicular, distribución irregular. • Nucleolos más prominentes • Diatesis tumoral menos aparente, consistente en agregados proteínicos y restos inflamatorios Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 28. ADENOCARCINOMA ENDOCERVICAL Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 29. ADENOCARCINOMA INVASOR • El adenocarcinoma invasor debe ser fuertemente considerado ante la presencia de diátesis tumoral, aclaramiento nuclear, distribución irregular de la cromatina, macronucleolo. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 30. ADENOCARCINOMA ENDOCERVICAL Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 31. ADENOCARCINOMA ENDOMETRIAL • forma individual o grupos apretados. • Tumores bien diferenciados, el núcleo suele estar ligeramente alargado • Variación del tamaño nuclear y pérdida de la polaridad • Núcleo muestra moderada hipercromasia, distribución irregular de cromatina • Nucleolos pequeños a prominentes. • Diatesis tumoral “acuosa” o granular. Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 32. ADENOCARCINOMA ENDOMETRIAL (CC) Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 33. ADENOCARCINOMA ENDOMETRIAL Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 34. ADENOCARCINOMA ENDOMETRIAL Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
- 35. ADENOCARCINOMA ENDOMETRIAL Ritu Nayar, ”The Bethesda system for reporting cervical pathology” third edition Ebook, 2015, Springer.
Notas del editor
- Atypical endocervical cells, most likely from a reparative process ( CP ). Routine screen from a 39-year-old woman. Sheet of cells that demonstrate nuclear enlargement, increased nuclear to cytoplasmic (N/C) ratios, prominent, sometimes multiple nucleoli, and mitotic activity. Threeyear follow-up showed NILM cytology
- Atypical endocervical cells, not otherwise specifi ed (NOS) ( LBP , ThinPrep ). Cluster of slightly crowded endocervical cells with some nuclear crowding and round to oval nuclei showing washed-out chromatin. Follow-up showed tubal metaplasia. The terminal bars and cilia were difficult to visualize in this case. The fine granularity of the chromatin pattern is an important feature of cases that are derived from tubal metaplasia
- Atypical endocervical cells, NOS ( CP ). Cluster of cells with crowding and overlapping of nuclei, nuclear enlargement, chromocenters, and small nucleoli. Follow-up biopsies showed high-grade squamous intraepithelial lesion (HSIL) with extension into endocervical glands
- Atypical endocervical cells, favor neoplastic ( CP ). Routine screen from a 29-year-old woman. Sheet of crowded cells with increased N/C ratios and mitotic activity. Note feathering at the edges of the sheet. Follow-up showed endocervical AIS
- Atypical endocervical cells, favor neoplastic ( CP ). Pseudostratified strip of endocervical cells with enlarged, elongated nuclei and evenly distributed chromatin granularity
- Atypical endometrial cells ( CP ). An 82-year-old woman with postmenopausal bleeding. Three-dimensional groups of small cells with mildly hyperchromatic nuclei, small nucleoli, and occasionally vacuolated cytoplasm. ( a ) shows a very tight cluster, while ( b ) shows a more loosely aggregated group. Follow-up showed endometrial hyperplasia
- Atypical endometrial cells ( LBP , ThinPrep ). Small groups of cells with slightly enlarged nuclei, small nucleoli, and vacuolated cytoplasm. ( a ) A 63-year-old woman. Follow-up showed endometrial adenocarcinoma grade 1. ( b ) A 55-year-old woman. Follow-up showed endometrial hyperplasia
- Endocervical adenocarcinoma in situ ( LBP , SurePath ). Routine screen from a 25-yearold woman. Pseudostratifi ed strips of cells often present as short “bird tail-like” arrangements in SP as seen on the right side of this image ( b ). Feathering, although less prominent than in conventional smears, is demonstrated on the left ( a ). Follow-up showed AIS
- Adenocarcinoma, endocervical ( LBP , ThinPrep ). A 46-year-old woman. Cell nuclei may have more vesicular chromatin with irregular distribution and chromatin clearing as well as macronucleoli. Follow-up showed invasive endocervical adenocarcinoma
- Adenocarcinoma, endocervical ( LBP , ThinPrep ). A 39-year-old woman on day 12 of menstrual cycle. Tumor diathesis may be less prominent and seen as debris clinging to the periphery of the abnormal cell clusters in LBP s. Follow-up showed invasive endocervical adenocarcinoma
- Adenocarcinoma, endocervical ( CP ). Nuclei are enlarged and pleomorphic with irregular chromatin distribution and prominent or macronucleoli. Cytoplasm is finely vacuolated. Note the prominent blood-filled background
- Endometrial adenocarcinoma, high grade. ( a ) A 61-year-old woman with postmenopausal bleeding ( CP ). ( b ) A 57-year-old woman with PM bleeding ( LBP , ThinPrep ). High-grade endometrial adenocarcinoma is characterized by tight clusters of glandular endometrial type cells with enlarged hyperchromatic nuclei and a clinging granular diathesis as well as a precipitate of acellular diathesis material in the background. Nucleoli are prominent, and chromatin is coarse and irregularly distributed. As grade increases, larger numbers of cells are shed and present in the cervical cytologic specimen. Both cases seen here had histologic follow-up of endometrial adenocarcinoma FIGO grade 3
- Adenocarcinoma, endometrial, high grade ( CP ). A 58-year-old woman with postmenopausal bleeding. Nuclei in higher-grade tumors are larger and display moderate hyperchromasia with irregular chromatin distribution. Note finely granular diathesis in background. Follow-up showed high-grade endometrial adenocarcinoma
- Adenocarcinoma, endometrial, high grade ( CP ). Tumor diathesis, if present, is watery and may be diffi cult to appreciate