Does anyone know what glandular involvement means with high grade SIL? I tried looking it up but only found mentions of it along with other terms, but could not find exactly what it means...
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 just wanted to add:
I have found the same thing, Baybreeze.
Just to note:
I had a PAP in May, results were HGSIL.
I had Biopsy in June, results were HGSIL CINII/III.
ECC at same time results were "scant fragments of benign endocervical tissue."
Repeat PAP at same time results were HGSIL.
LEEP procedure in August, results were HGSIL CINII/III with gland(crypt) involvement.
So I never had an AGUS result on a pap, just the HGSIL with gland involvement on the LEEP pathology. Margins were clear though. 1st followup pap is in a week and a half!
But back to your original question, the only thing I found about gland involvement is that the rate of reocurrance is higher than without. So, we'll see.
Good Luck!
My cone biopsy showed carcinoma in situ involving the endocervical glands/CIN II and III to the edges. Are these the glands we are talking about? Your findings that this is rare go against what my doctor said. She said she has seen glandular involvement many, many times before. I have to wonder if she just said that to ease my mind. For her to see it many, many times (going by the percentage you quoted) she would have to have had thousands of patients with at least severe dysplasia. She's only been in practice for 12 years. It really makes me wonder!!
Sharon - I know my doc explained something about the glandular part to me but I don't remember exactly what she said. So I'm not sure what kind of glandular involvement it is, but I do remember that the margins were unclear.
Leep - I had a pap, my gyno personally called me stating my results were quite disturbing & and that I needed colposcopy right away, which I did. Several biopsies were taken during the colposcopy and when I went back for a results consultation, she said my tests came back "hsil with glandular involvement". I do not know, though, what CIN it is or if the glandular involvement showed on the actual pap.
Nia - thanks for all that info. I did some searching about AGUS after reading your reply and also read in several places that it's an uncommon finding - but again, I just can't remember what glands. My gyno said because of these findings, I have to get a cold knife cone biopsy under general anesthesia <ughh>....she can't just do a LEEP procedure. She talked about it being possible that I have cancer and if I do I will probably have to have a hysterectomy. <i'm getting sick just thinking about this..but it is what it is>
Thanks again everyone for any information that you could give me!
Read the posts on carcinoma in situ before you decide on anything!!! I told you my diagnosis - not good. So, I had the majority of my cervix taken out (I kid you not 2.5cm x 2.5 cm x 1.5cm - the average cervix is 3cm thick) under general and I also had a D&C, ECC's, ablation and a laproscopic tubal ligation so as to avoid a hysterectomy...she basically "cleaned me out" and left everything intact - and a smidge of cervix to boot (LOL). I had unclear margins...bad stuff to the edges. I was given hysterectomy as an option, but we are doing a wait and see thing because my last biopsies showed only atypical cells. Will they progress?? Who knows. But, I am not going to get gutted until they show me proof that they have. Two months ago I had resigned myself to the hysterectomy being the only option, but I have renewed faith and am sooo glad I waited before doing anything. Keep your faith!!
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?
I can't seem to figure it out. Every thing I look up, the results come back with AGUS or ASCUS. I've seen a couple things where it mentioned highgrade SIL with glandular involvement, but no where does it say what that means <arghhh>. I know my doc said something about it..I just wish my memory/brain fog wasn't so bad. Either way, I guess I would still need a cold knife cone biopsy to see if that gets rid of everything or if I have cancer. Thanks again everyone, for trying to help
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.
