“Arias-Stella reaction”-like changes in endocervical glandular epithelium in cervical smears during pregnancy and postpartum states—a potential diagnostic pitfall
✍ Scribed by J.L. Benoit; S.R. Kini
- Book ID
- 102652813
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 811 KB
- Volume
- 14
- Category
- Article
- ISSN
- 8755-1039
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✦ Synopsis
A wide spectrum of histologic changes has been described throughout the female genital tract duringpregnancy and in the postpartum period. Of these, the endometrial glandular changes referred to as the Arias-Stella reaction have classically been a diagnostic pitfall in histologic sections. Pregnancy-related changes are also rejected in cytologic material obtained from the cervix and vagina. Both glandular and stromal alterations may be seen. The changes involving endocervical glandular epithelium are ofen alarming enough to cause diagnostic dijiculties, especially when the history ofpregnancy is notprovided. We report I 3 cases where marked glandular changes led to diagnostic misinterpretations. These were characterized by cyto-and karyomegaly, a high nuclear to cytoplasmic ratio, round to oval nuclei with smudgy chromatin imparting a ground glass appearance, frequent intranuclear inclusions, and vacuolated to dense variable cytoplasm. The cytologic diagnoses ranged from "glandular atypia" to "suspicious for adenocarcinoma. " Follow-up was available in 11/13 cases. In 9/11 cases, subsequent cervical smears on multiple occasions were negative. Cervical biopsies and/or dilatation and curettage in 4/11 cases did not show signiJcant glandular abnormalities. The glandular changes encountered in cytologic material were similar to those described histologically in the Arias-Stella reaction involving the cervix. This similarity and the fact that these changes disappeared upon termination of the pregnancy favors the presumption thar they represent the Arias-Stella reaction. Awareness of these changes during pregnancy and postpartum may prevent interpretive errors and unnecessary surgical procedures.