Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2005 Feb;3(1):13-8.
doi: 10.3121/cmr.3.1.13.

Atypical Papanicolaou smear in pregnancy

Thomas P Connolly  1 , A C Evans
Affiliations
Case Reports

Atypical Papanicolaou smear in pregnancy

Thomas P Connolly et al. Clin Med Res. 2005 Feb.

Abstract

Atypical glandular cells (AGC) in Papanicolaou (Pap) smears can be associated with premalignant and malignant cervical and endometrial lesions. AGC is difficult to diagnose in pregnancy due to confusion with normal cellular changes that accompany graviditas. While guidelines have been established for management of AGC cases in the non-pregnant patient, special considerations are required when this is discovered during a pregnancy. A routine Pap smear performed on a 29-year-old woman being seen for a history of infertility yielded AGC and a high-grade squamous intraepithelial lesion. The patient achieved pregnancy 1 month later. Satisfactory colposcopic exam was performed with cytobrush sampling of the endocervical canal, in addition to 2 exocervical biopsies at 11 weeks gestation. Positive diagnosis of endocervical adenocarcinoma in situ resulted in a risk-informed decision to proceed with a cold knife conization of the cervix. Final pathology showed complete resection of the lesion with negative margins and an additional area of squamous dysplasia (cervical intraepithelial neoplasia, grade II to III). Appropriate follow-up was recommended. AGC found upon Pap smear during a pregnancy can be associated with significant pathology for which an aggressive management approach is warranted.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
High grade squamous intraepithelial lesion (squamous carcinoma in situ) on Pap smear (Papanicolaou stain, x400).
Figure 2.
Figure 2.
Cervical biopsy showing endocervical adenocarcinoma in situ (thick arrow) and adjacent severe squamous dysplasia (CIN III) (thin arrow) (H&E, x200).
Figure 3.
Figure 3.
Residual endocervical adenocarcinoma in situ on the cone biopsy with focal severe squamous dysplasia (CIN III) and negative margins (H&E, x100).
Figure 4.
Figure 4.
Algorithm for management of atypical glandular cells (AGC) in pregnancy.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kaferle JE, Malouin JM. Evaluation and management of the AGUS Papanicolaou smear. Am Fam Physician. 2001;63:2239–2244. - PubMed
    1. Eddy GL, Strumpf KB, Wojtowycz MA, Piraino PS, Mazur MT. Biopsy findings in five hundred thirty-one patients with atypical glandular cells of uncertain significance as defined by the Bethesda system. Am J Obstet Gynecol. 1997;177:1188–1195. - PubMed
    1. Raab SS, Bishop NS, Zaleski MS. Effect of cervical disease history on outcomes of women who have a pap diagnosis of atypical glandular cells of undetermined significance. Gynecol Oncol. 1999;74:460–464. - PubMed
    1. Massad LS, Collins YC, Meyer PM. Biopsy correlates of abnormal cervical cytology classified using the Bethesda system. Gynecol Oncol. 2001;82:516–522. - PubMed
    1. Reuss E, Price J, Koonings P. Atypical glandular cells of undetermined significance. Subtyping as a predictor of outcome. J Reprod Med. 2001;46:701–705. - PubMed

Publication types