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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 [HSIL and LSIL]). The ASC designation has been subdivided into “atypical squamous cells of undetermined significance” (ASCUS) and “atypical squamous cells cannot exclude HSIL” (ASCH). The latter includes the 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.
Prevalence: ASC—approximately 3% of all Pap tests; AGC—0.2% of all Pap tests.
Predominant Age: Reproductive age.
Genetics: No genetic pattern.
Causes: If not all, most of the changes 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.
Risk Factors: ASC—exposure to high-risk HPV. AGC—none known, except for those affecting possible pathologic causes (eg, unopposed estrogen therapy as a risk factor for endometrial carcinoma).
Asymptomatic
ASC—inflammatory change (cervicitis)
LSIL change
AGC—benign reactive changes in endocervical or endometrial cells
Endometrial hyperplasia or adenocarcinoma
Endometritis secondary to an intrauterine contraceptive device
Tuberculous endometritis
Tubal carcinoma
Associated Conditions: ASC—HPV infection, vaginitis, cervicitis. AGC—dysfunctional uterine bleeding (may be present but is most often absent).
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