Chapter 97 Abnormal Pap Test Result: Atypical Squamous or Glandular Cells
INTRODUCTION
Description: One of the most perplexing aspects of management under the Bethesda reporting system is how to interpret smears reported as showing atypical squamous or glandular cells (ASCUS, ASCH, or AGC). The atypical squamous cell (ASC) diagnosis has been developed to describe squamous cell changes that are more severe than reactive changes but not as marked as those found in squamous intraepithelial lesions (SIL, high and low grade). The ACS designation has been subdivided into “atypical squamous cells of undetermined significance” (ASCUS) and “atypical squamous cells cannot exclude HSIL” (ASCH). The latter includes those cytologic changes suggestive of HSIL but insufficient for a definitive diagnosis. The category of atypical glandular cells (AGC) includes a range of findings from benign reactive changes in endocervical or endometrial cells to adenocarcinoma.
ETIOLOGY AND PATHOGENESIS
Causes: Most, if not all, of the changes that are seen result from infection by the human papillomavirus (HPV). The AGC diagnosis reflects benign reactive changes in endocervical or endometrial cells, endometrial hyperplasia, or adenocarcinoma.
