宫颈液基薄层细胞学检查中AGC-FN的临床病理特征OA

Objective:Cervical glandular epithelial lesions are often occult and challenging to interpret cytologically.Atypical glandular cells-favor neoplasia(AGC-FN),as a high-risk cytological subtype,remains controversial in clinical management.This study aims to investigate the cytopathological characteristics,human papilloma virus(HPV)positivity rate,diagnosis,and differential diagnosis of AGC-FN identified by cervical thinprep cytologic test(TCT). Methods:Cases diagnosed as AGC-FN from January 2023 to October 2025 were collected from the Departments of Pathology at Suzhou BenQ Medical Center,Chongqing Health Center for Women and Children,and Xi'an Daxing Hospital.The association between AGC-FN and HPV infection was statistically analyzed,and cytopathological characteristics were retrospectively reevaluated. Results:Among 226 533 TCT examinations performed at the three hospitals,57 cases were diagnosed as AGC-FN.Final diagnoses were established in 39 cases,including 11 cases(28%)of endocervical adenocarcinoma,20 cases(51%)of endometrioid carcinoma,1 case(3%)of ovarian carcinoma,and 7 cases(18%)of high-grade squamous intraepithelial lesion(HSIL)involving endocervical glands.Among the 18 cases of endocervical adenocarcinoma and HSIL involving glands,17 were HPV-positive,showing a close association with HPV infection.In contrast,all cases of endometrioid carcinoma and ovarian carcinoma were HPV-negative,suggesting no association with HPV infection.Cytological reevaluation revealed 4 major categories of malignant lesions:1)HPV-associated usual-type endocervical adenocarcinoma or HSIL involving endocervical glands.Cells showed enlarged and elongated nuclei with palisading and feathering arrangements.Cases with HSIL involving glands simultaneously exhibited atypical squamous cells with increased nuclear-to-cytoplasmic ratios and atypical glandular cells.2)Invasive stratified mucin-producing carcinoma(ISMC).Cells were arranged singly or in stratified clusters,with abundant intracellular mucin.The nuclei were round with mild to moderate atypia.3)Endometrioid carcinoma.Cytological features mainly included micropapillary clusters and glandular structures,occasionally accompanied by scattered neutrophils.Well-differentiated tumors showed coarse chromatin with inconspicuous nucleoli,whereas poorly differentiated tumors exhibited enlarged nuclei and prominent nucleoli.4)High-grade serous carcinoma of the ovary.Tumor cells were scattered singly,with increased nuclear-to-cytoplasmic ratios and prominent nucleoli.During follow-up ranging from 1 to 34 months,35 cases remained alive,1 case died,and 3 cases were lost to follow-up. Conclusion:AGC-FN is a rare cytological finding in TCT.Endometrioid carcinoma accounts for a higher proportion of cases than endocervical adenocarcinoma.HPV testing provides important clues regarding the origin of AGC-FN lesions.In cervical cytology evaluation,greater attention should be paid to cellular arrangement patterns,and HPV results should be integrated to facilitate identification of the lesion origin.