for an enlarged view.

Criteria

Tissue Presentation

• Flat sheets
• Well organized
• “School of fish” arrangement

Atypical Endocervical Cells (NOS)
A well organized, flat sheet of glandular cells in a “school of fish” arrangement. Biopsy – Decidual changes-20x

Cytoplasm

• Abundant
• “Tissue culture” appearance

Atypical Endocervical Cells (NOS)
Pictured is a sheet of endocervical cells with slightly disordered architecture, slight depth of focus to group, abundant cytoplasm, uniform, bland chromatin pattern and prominent nucleoli in each nucleus. The diagnosis of atypia may arise due to depth of focus to the group and slightly disordered architecture. Biopsy – Inflammatory Atypia – 60X

N/C Ratio

• Low

Atypical Endocervical Cells (NOS)
Atypical cells with abundant cytoplasm maintaining a low N/C ratio. Biopsy – Endocervical polyp – 60x

Nucleus

• Oval to round

Atypical Endocervical Cells (NOS)
The specimen contains a rounded up (3-dimensional) group of endocervical cells with slight disruption to architecture. Nuclei are all similar in size and nuclear membranes are smooth to slightly irregular.
Biopsy – Chronic Inflammation – 60x

Nuclear Membrane

• Smooth
• Possible slight irregularities
• Possibly slightly thickened

Atypical Endocervical Cells (NOS)
The nuclei in this group exhibit nuclear membranes with slight irregularities and thickening.
Biopsy – Decidual changes – 40x

Chromatin

• Granular
• Evenly distributed
• Uniformly hypochromatic

Atypical Endocervical Cells (NOS)
A loose grouping of endocervical cells exhibits an apparent loss of polarity. Nuclei are round to oval with slight nuclear membrane irregularities and slight crowding. The chromatin is granular but evenly distributed and prominent nucleoli are present. Biopsy – Chronic Inflammation – 60x

Nucleoli

• In every nucleus
• Single to multiple
• Small to moderate

Atypical Endocervical Cells (NOS)
Nuclei contain single to multiple nucleoli that are small to moderate in size.
Biopsy – Decidual changes – 60x

Look Alikes for Atypical Endocervical Cells (NOS)

Endocervical Repair:

Cell Type: Endocervical
Tissue Presentation

• Flat, loose sheet

Look Alike for Atypical Endocervical Cells (NOS)
Repair – Note the flatness of this sheet of reparative cells. All of the nuclei are in the same plane and lack the nuclear crowding characteristic of AIS. Nuclei are uniformly spaced and round to oval, rather than elongate. 40x

Look Alike for Atypical Endocervical Cells (NOS)
Endocervical repair – 40x

Unique Features

• “School of fish” tissue appearance
• Low N/C ratio
• Prominent nucleoli

Look Alike for Atypical Endocervical Cells (NOS)
Repair often shows “school of fish” architecture. Polarity is maintained and the N/C ratio of the cells is in the normal range. 40X

Look Alike for Atypical Endocervical Cells (NOS)
Repair shows smooth nuclear contours and polarity is maintained within group. 60x

Look Alike for Atypical Endocervical Cells (NOS)
Repair can present with prominent nucleoli, some multiple. 40x

Look Alike for Atypical Endocervical Cells (NOS)
Repair may contain mitosis and macronucleoli. 60x

Tubal Metaplasia:

Cell Type: Small cuboidal fallopian tube-type glandular cells
Tissue Presentation

• Crowded honeycomb presentation

Look Alike for Atypical Endocervical Cells (NOS)
Tubal metaplasia can closely mimic AIS. However, on close inspection the abnormalities, ie: crowding, nuclear elongation, irregular nuclear membranes and abnormal tissue fragments are less severe. Locating cilia and/or terminal bars confirms benignancy. 60X

Look Alike for Atypical Endocervical Cells (NOS)
Crowded glandular cells have enlarged nuclei but a closer inspection reveals evenly distributed chromatin. 40x

Unique Features

• Terminal bars and cilia

Look Alike for Atypical Endocervical Cells (NOS)
A strip of columnar cells with hyperchromatic, crowded nuclei. Close observation reveals distinct cytoplasmic vacuoles and cilia possibly representing tubal metaplasia. 60X

Look Alike for Atypical Endocervical Cells (NOS)
In this higher power view of the first photograph (20x) a distinct row of cilia is evident. 60x

Lower Uterine Segment:

Cell Type: Endometrial
Tissue Presentation

• Honeycomb presentation with overlapping nuclei, often in large sheets

Look Alike for Atypical Endocervical Cells (NOS)
A fragment of cells from the lower uterine segment, which has folded over itself causing a three dimensional appearance. 20X

Look Alike for Atypical Endocervical Cells (NOS)
Lower uterine segment – 40X

Look Alike for Atypical Endocervical Cells (NOS)
Lower uterine segment may have prominent nucleoli. 40X

Unique Features

• Very small cells with scant cytoplasm and uniform appearance

Look Alike for Atypical Endocervical Cells (NOS)
This tissue fragment of lower uterine segment is composed of small, cuboidal cells with uniform nuclei and bland chromatin. At low power the cells appear crowded; however on closer inspection they are simply tightly packed. The cohesiveness and uniformity of such fragments at low power are the keys to diagnosis. A stromal component is usually present as well and is an aid in diagnosis. 20x

Atypical Endocervical cells favor Neoplasia or AIS:

Cell Type: Endocervical
Tissue Presentation

• Strips of tissue with nuclear crowding
• Stratification
• Feathering

Look Alike for Atypical Endocervical Cells (NOS)
Endocervical cells presenting in a strip with pronounced nuclear crowding. Biopsy – AIS – 60x

Look Alike for Atypical Endocervical Cells (NOS)
A strip of endocervical cells exhibiting pseudostratification and finely vacuolated cytoplasm with indistinct cytoplasmic borders. Architecture is disrupted although cells are still attempting to maintain a glandular configuration. Note increased N/C ratio and the variable presence of nucleoli. Biopsy – AIS – 60x

Look Alike for Atypical Endocervical Cells (NOS)
Endocervical cells presenting in a pseudo-rosette formation and exhibiting “feathering” and nuclear elongation due to crowding. Biopsy – AIS – 60x

Unique Features

• Nuclear crowding
• Stratification
• No cilia or terminal bars identified

Look Alike for Atypical Endocervical Cells (NOS)
Nuclear elongation is clearly evident in this group of atypical endocervical cells. Also noted is loss of nuclear polarity, loss of normal architecture, nuclear crowding, and “molding” of the nuclei. Note the flat nuclear membranes where they push up against each other (a sign of true crowding). Biopsy – AIS – 60x

Look Alike for Atypical Endocervical Cells (NOS)
AIS – This crowded, stratified group of glandular cells comes from a case of AIS. Note the basal nuclei piling up from the lower layer of the epithelium. 60x