Difficulties and possibilities of cytodiagnosis of origin of adenocarcinoma in cervical smears

BACKGROUND: The duration and accuracy of verification of origin and morphological variant of adenocarcinoma in the cervical smear affect the effectiveness of the treatment of patients. Currently, few publications on the possibility of clarifying the origin of adenocarcinoma in a cervical smear using the traditional cytological method are not sufficient for evidence-based conclusions. AIMS: To identify patterns of cytological indicators of origin of adenocarcinoma in the biomaterial from the cervix. MATERIALS AND METHODS: In an observational one-stage retrospective study, a comparative analysis of cytological tests of cervical smears with the conclusion adenocarcinoma was carried out with clinical and anamnestic information and the results of histological, immunohistochemical, molecular and genetic examinations. Information about 143 patients in the cancer registry of the Altai Regional Oncological Dispensary (Barnaul) for 2021 was used for analysis. Cytology preparations were prepared by the traditional method, as well as by the method of liquid cytology, staining was carried out by the Papanicolaou (Pap Test) and Pappenheim methods. Testing for human papillomavirus (HPV) was carried out by immunohistochemical method and polymerase chain reaction. PIK3CA and KRAS mutations were detected by polymerase chain reaction. RESULTS: The cytological conclusion adenocarcinoma was confirmed by histology for all 143 women. There were cytology features of the morphological variant of AC, as well as to suggest the primary organ of adenocarcinoma, subsequently verified by visualization methods, histological, immunohistological examinations of biopsy and/or surgical material. The adenocarcinoma elements in the cervical smear was accompanied by adenocarcinoma in the endometrium, cervix, ovary/fallopian tube, colon (68.5, 17.6, 9.8 and 2.8% of cases, respectively; p 0.001). Differentiation of endometrial adenocarcinoma varied. Clear cell adenocarcinoma had specific cellular features. Cellular characteristics of HPV-associated and HPV-unassociated endocervical carcinomas differed from each other. Invasion of intestinal adenocarcinoma into the uterus and cervix was characterized by complexes with a palisade arrangement of cells in cervical smears. CONCLUSION: Cytolodiagnostics of adenocarcinoma in smear from the cervix has prospects for further improvement in the verification of the organ origin of carcinoma. It is assumed that it is rational to assess associations of cytology with histo-, cytochemical, molecular and genetic characteristics of adenocarcinoma.