Atypical Glandular Cells

• Atypical Glandular Cells (AGC) are abnormal glandular cells detected during a Pap test.
• AGC findings are less common than atypical squamous cells but carry a higher risk of underlying high-grade lesions or cancer.
• Further diagnostic procedures, such as colposcopy, endocervical sampling, and endometrial biopsy, are crucial for proper evaluation.
• The causes of atypical glandular cells can range from benign conditions like inflammation to pre-cancerous changes or even invasive cancer.
• Timely and appropriate follow-up is essential for accurate diagnosis and effective management.

What is Atypical Glandular Cells (AGC)?

Atypical Glandular Cells (AGC) refers to a category of abnormal cells identified during a routine Pap test. These glandular cells are responsible for producing mucus and are found in the endocervical canal (the opening of the cervix) and the lining of the uterus. When a Pap test reveals AGC, it means that these cells show changes that are not clearly benign but also not definitively cancerous, indicating a need for further evaluation.

Understanding the atypical glandular cells meaning is crucial: it is not a diagnosis of cancer, but rather a finding that warrants a more thorough examination. AGC is less common than atypical squamous cells (ASCUS) but is associated with a higher risk of underlying serious pathology, including high-grade pre-cancerous lesions or invasive cancer. According to the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines, AGC is reported in approximately 0.2% to 0.5% of all Pap tests, highlighting its relative rarity but significant clinical importance.

Interpreting AGC Pap Test Results

When an AGC Pap test results explained by your healthcare provider, it typically means that additional diagnostic steps are required. Unlike some other abnormal Pap test results that might allow for watchful waiting, AGC findings prompt immediate and comprehensive follow-up due to the elevated risk of detecting significant disease. The specific type of follow-up depends on factors such as the subcategory of AGC (e.g., AGC-NOS, AGC-favor neoplastic), the patient’s age, and clinical history.

Common diagnostic procedures recommended after an AGC result include:

• Colposcopy with directed biopsies: This procedure uses a magnifying instrument to examine the cervix, vagina, and vulva for abnormal areas, from which tissue samples (biopsies) are taken.
• Endocervical sampling (ECC): A small brush or curette is used to collect cells from inside the endocervical canal, where glandular cells originate.
• Endometrial biopsy: For women over 35, or those with risk factors for endometrial cancer, a sample of the uterine lining may be taken to check for abnormalities.

These evaluations aim to identify the exact nature of the cellular changes and rule out or confirm the presence of pre-cancerous conditions or cancer of the cervix or endometrium.

Potential Causes of Atypical Glandular Cells

The causes of atypical glandular cells are diverse, ranging from benign conditions to more serious pre-cancerous or cancerous lesions. It is important to remember that AGC is a descriptive finding, not a definitive diagnosis, and its underlying cause must be determined through further investigation. Potential causes include:

• Benign Conditions: These can include inflammation or infection (such as Human Papillomavirus (HPV) or chlamydia), reactive cellular changes due to irritation, or the presence of benign polyps in the endocervical canal. Hormonal changes can also sometimes lead to atypical glandular cell appearances.
• Pre-cancerous Lesions: AGC can indicate the presence of high-grade squamous intraepithelial lesions (HSIL) that extend into the glandular tissue, or adenocarcinoma in situ (AIS), which is a non-invasive glandular pre-cancer.
• Cancer: In some cases, AGC may be the first indicator of an invasive adenocarcinoma of the cervix or, less commonly, an endometrial adenocarcinoma. The risk of finding an invasive cancer after an AGC result is higher than with other atypical Pap test findings.

Given this spectrum of possibilities, a thorough diagnostic work-up is essential to accurately identify the cause of AGC and ensure appropriate and timely management.