Mehmet ZENGIN, Suat BENEK, Müjgan GÜRLER, Merve ERYOL

Arias-Stella reaction and frightening cytological changes in endocervical polyp: a rare case report

The Arias-Stella (AS) reaction is hormone-dependent atypical endometrial changes characterized by hyperplasia, hypertrophy, vacuolization, pronounced nuclear atypia, pronounced nuclear pleomorphism, and prominent nuclear hyperchromasia in glandular epithelial cells. It is very rare to see AS-related changes in extra uterine areas, especially in an endocervical polyp. Since this benign lesion is very similar to misdiagnoses such as adenocarcinoma, it is very critical to recognize AS reaction in extrauterine areas. The interpretation of pathological findings involves many difficulties, for example, due to the generally small size and fragmentation. Considering the clinical history and good interpretation of the nuclear details are extremely important for correct diagnosis. Here, we present the frightening cellular changes associated with AS observed in an endocervical polyp encountered after abortion in a middle-aged pregnant woman, together with the literature findings.

Keywords:

Endocervical polyp, Arias-Stella reaction, frightening cytological changes,

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Arias-Stella J. A topographic study of uterine epithelial atypia associated with chorionic tissue: demonstration of alteration in the endocervix. Cancer 1959; 12: 782–90.
Arias-Stella J. The Arias-Stella reaction: facts and fancies four decades after. Adv Anat Pathol 2002; 9: 12–23.
Felix A, Nogales FF, Arias-Stella J. Polypoid endometriosis of the uterine cervix with Arias-Stella reaction in a patient taking phytoestrogens. Int J Gynecol Pathol 2010; 29: 185–8.
Huettner PC, Gersell DJ. Arias-Stella reaction in nonpregnant women: a clinicopathologic study of nine cases. Int J Gynecol Pathol 1994; 13: 241–7.
Cariani DJ, Guderian AM. Gestational atypia in endocervical polyps – the Arias-Stella reaction. Am J Obstet Gynecol 1966; 95: 589–90.
McCormick CJ, Menai-Williams RA. Tripolar mitotic figures occurring in an Arias-Stella reaction within an endocervical polyp. Histopathology 1995; 26: 575–6.
Rhatigan RM. Endocervical gland atypia secondary to Arias-Stella change. Arch Pathol Lab Med 1992; 116: 943–6.
Nucci MR, Young RH. Arias-Stella reaction of the endocervix: a report of 18 cases with emphasis on its varied histology and differential diagnosis. Am J Surg Pathol 2004; 28: 608–12.
Schneider V. Arias-Stella reaction of the endocervix: frequency and location. Acta Cytol 1981; 25: 224–8.
Cove H. The Arias-Stella reaction occurring in the endocervix in pregnancy: Recognition and comparison with an adenocarcinoma of the endocervix. Am J Surg Pathol 1979; 3: 567–8.
Vang R, Barner R, Wheeler DT, et al. Immunohistochemical staining for Ki-67 and p53 helps distinguish endometrial Arias-Stella reaction from high-grade carcinoma, including clear cell carcinoma. Int J Gynecol Pathol 2004; 23: 223–33.
Lipper S, Benson JD. Mitoses in the Arias-Stella reaction. Arch Pathol Lab Med 1981; 105: 116-7.
Arias-Stella J, Jr, Arias-Velasquez A, Arias-Stella J. Normal and abnormal mitoses in the atypical endometrial change associated with chorionic tissue effect. Am J Surg Pathol 1994; 18: 694–701.
Benoit JL, Kini SR. “Arias-Stella reaction”-like changes in endocervical glandular epithelium in cervical smears during pregnancy and postpartum states – a potential diagnostic pitfall. Diagn Cytopathol 1996; 14: 349–55.
Pisharodi LR, Jovanoska S. Spectrum of cytologic changes in pregnancy. A review of 100 abnormal cervicovaginal smears, with emphasis on diagnostic pitfalls. Acta Cytol 1995; 39: 905-8.
Kobayashi TK, Okamoto H. Cytopathology of pregnancy-induced cell patterns in cervicovaginal smears. Am J Clin Pathol 2000; 114: S6–20.
Greeley C, Schroeder S, Silverberg SG. Microglandular hyperplasia of the cervix: a true “pill” lesion? Int J Gynecol Pathol 1995; 14: 50–4.
Young RH, Scully RE. Atypical forms of microglandular hyperplasia of the cervix simulating carcinoma. A report of five cases and review of the literature. Am J Surg Pathol 1989; 13: 50–6.
Matias-Guiu X, Lerma E, Prat J. Clear cell tumors of the female genital tract. Semin Diagn Pathol 1997; 14: 233–9.
Terada T. Clear cell adenocarcinoma of the uterine cervix in a young pregnant woman: a case report with immunohistochemical study. Med Oncol 2011; 28: 290–3.
Nucci MR. Symposium part III: tumor-like glandular lesions of the uterine cervix. Int J Gynecol Pathol 2002; 21: 347–59.