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Cancer: Cervical & Ovarian Message Board


Cancer: Cervical & Ovarian Board Index


Ok, I have to post this since it's unlikely there are many with this diagnoses. I had glandular cells involvement on my PAP as well; and had the toughest time finding out anything at all.

I had similar PAP as yours, went on to get biopsy and then LEEP.
PAP showed LSIL with glandular involvement; biopsy - CIN II and III both (ouch). But...I just had my LEEP results back; it's actually CIN II only as opposed to III, and the margins were clear all around, as well as ECC scraping. Whew.

Here are some facts I've gathered, listed sources as well.

1. AGUS/glandular involvement is a rare finding, appearing only in about .5-2% of PAPs
2. It’s under-studied and little is know about it
3. It’s has a significant value however, as an indicator that CIN beyond I is present, likely CIN III (please note that does NOT mean you have cancer or are likely to develop cancer. It means that when you show glandular involvement on PAP/Biopsy, you are likely to find CIN III on larger tissue biopsy like LEEP/Cone, from what I understand.
4. There may be lesion deep in the endo-cervical canal
5. There could be a relationship between AGUS (atypical glandular cells of undertermined significance) to adenocarsinoma type cancers which start in glandular cells (as oppose to squamous, like sarcoma) and can be more aggressive.
6. There is also some evidence that AGUS on PAPs can be caused by certain benign conditions, but you want to get a biopsy ASAP to rule out invasion.

Again, I want to emphasize that these are brand-new findings and not much is known of AGUS. Thus, all that's certain that it's an additional warning sign (like presence of HPV 16, age, smoking, size and location of lesion).

I URGE you to do a tissue biopsy like LEEP or Cone ASAP, don't worry but just to get things going and to ease your mind.


Sources used:
1. Revue / Journal Title
Acta cytologica (Acta cytol.) ISSN 0001-5547 CODEN ACYTAN , 2003, vol. 47:
“By logistic regression analysis, we found that the chance of finding squamous intraepithelial lesions involving glands in AGUS smears was 5.32 times higher than in those with no AGUS. It was 5.74 times higher in cervical intraepithelial neoplasia (CIN) 3 lesions than in CIN 2”

2. BMC Cancer. 2004; 4: 37.
Published online 2004 July 19. doi: 10.1186/1471-2407-4-37:

"RESULTS:
Out of 183 AGC-NOS diagnosed, 56.3% (103/183) were associated with tissue-proven precancerous and/or cancerous lesions, 44% being of endocervical and 56% of endometrial origin. 75% of all AGC-patients were asymptomatic. 66.7% (6/9) of the patients with subsequent invasive endocervical adenocarcinoma (AC) and 56% (28/50) of those patients with invasive endometrial AC were without clinical symptoms. 3 patients out of 9 with an invasive endocervical AC were 35 years of age or less. 10.1% and 12.3% of all 'new' tissue-proven invasive endocervical or endometrial AC respectively recorded by the national Morphologic Tumour Registry (MTR) were first identified by a cytological AGC-NOS diagnosis.

CONCLUSION:
Our findings emphasize the importance of the cytological AGC-category even in the absence of a precise origin or cell type specification. 56% of the AGC-diagnoses being associated with significant cancerous or precancerous conditions, a complete and careful evaluation is required".

Full text at:
[url]http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=497043[/url]
I believe that a AGUS result is different than SIL with glandular involvement.
AGUS is rare, SIL with gland involvement is more common.

Isn't AGUS (atypical grandular cells of undetermined significance) when the cells from the canal are the ones changing (possible precursor of adenocarcinoma)? But SIL is still the squamous cells but its invading the spaces of the glands in the cervix that produce cervical fluids?
Wait - you’re right, Leepoffaith!

Yes, the AGUS is entirely different from “SIL or CIN with glandular involvement”.

AGUS is the atypia of glandular cells (rare and related to adenocarcinomas).

ASCUS - CIN or SIL – squamous cells atypia.

From what I understand – glandular involvement – when it comes to CIN/SIL, is common and only indicative of higher grade CIN (II or III, as opposed to one). Nothing ELSE I can find – if someone did, please correct me.

I thought my own “glandular cell involvement” was related to AGUS on PAP, it is NOT; like the Baybreeze and Sharon I guess. So we’re better off then I thought at the very least ;)

Baybreeze – I’d ask your MD, if YOUR results showed AGUS – as opposed to ASCUS, at PAP/Colpo.

Do have a LEEP or Cone, whatever your doc suggests as appropriate. If this makes you feel better – my LEEP results were actually better then expected; big clear margins, small CIN II lesion on outer zone only, nothing going into endo-cervical canal.

But my colpo came with exact same results as yours (if you didn’t have AGUS); plus, there was a large, visible atypical blood vessel at 1 o’clock…. The doctor was nice enough to show me the photos and she mentioned all she was concerned about.
Needles to say, I was freaking out before my LEEP. I didn't even have a defense of good PAPS of the last 5 years... could have been anything (see my old *confession* post).

My MD was very pleased with the results of it, especially since I had CIN II only (not both II and III as colpo showed).

Don’t worry and get it done ASAP Baybreeze. I wish you most favorable results of your LEEP/Cone. Post an update and take good care of yourself.





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