Pap test results -
Atypical glandular cells (AGS)
This article was last reviewed and updated on December 24, 2019
by Adnan Karavelic, MD FRCPC
Atypical glandular cells means that abnormal cells were seen on your Pap smear. It is a description and not a final diagnosis.
Causes include cancer, infection, inflammation, pregnancy, or previous radiation to the cervix or endometrium.
Atypical glandular cells is used when your pathologist does not have enough information to decide if the abnormal groups of cells are cancerous or not.
After a diagnosis of atypical glandular cells, your doctor should plan to see you again within 6 months or should refer you to a specialist for additional tests.
The normal cervix and endometrium
The cervix is part of the female genital tract. It is found at the bottom of the uterus where it forms an opening into the endometrial cavity. The narrow passage that runs through the cervix from the endometrium to the vagina is called the endocervical canal.
The part of the cervix inside the vagina is called the exocervix. It is covered by special cells called squamous cells. These cells form a barrier called the epithelium that protect the cervix. The endocervical canal is covered by different kinds of cells that connect to make glands. These glands are called endocervical glands.
The inside of the endometrial cavity is called the endometrium. The endometrium is also covered by cells that connect to form glands. These glands are called endometrial glands.
Why is this important? Atypical glandular cells can come from either the endocervical glands or the endometrial glands.
Why is the Pap test performed?
The Pap test is a screening test designed to look for pre-cancerous and cancerous cells in the cervix. Sometimes, pre-cancerous and cancerous cells from the endometrium are also found on a Pap test although this is not the primary purpose of the test.
Read our introduction article to learn more about the Pap test.
Is it normal to see glandular cells on a Pap smear?
A normal Pap smear will show mostly squamous cells although it is normal to find small groups of glandular cells from the endocervix. Some Pap smears will also show small groups of glandular cells from the endometrium. This is considered normal in younger women.
However, seeing endometrial cells on a Pap smear from a postmenopausal woman is considered abnormal. For these women, an endometrial biopsy is recommended to investigate the source of the cells.
What are atypical glandular cells?
Atypical is a word pathologists use to describe cells that look abnormal when examined under the microscope. They are abnormal because they are different in shape, size, or color compared to the normal, healthy cells usually found in that area of the body.
Atypical glandular cells are larger than normal, healthy cells and the part of the cell that contains the genetic material of the cell, the nucleus, is darker. Pathologists call these cells hyperchromatic. There also tends to be greater variation in the size and shape of the nucleus between cells. In contrast, normal, healthy glandular cells all tend to be around the same size and shape.
When atypical glandular cells are seen, your pathologist will try to decide if the glandular cells are from the endocervix or the endometrium. If your pathologist was able to determine where the cells came from, it will be described in your report. The diagnosis atypical glandular cells means that your pathologist was unable to tell if the cells came from the endocervix or the endometrium.
Do atypical glandular cells mean cancer?
There are many reasons why glandular cells can become atypical. Reasons include cancer, infection, inflammation, pregnancy, or previous radiation to the cervix or endometrium. The description atypical glandular cells is used when your pathologist does not have enough information to decide if the abnormal groups of cells are cancerous or not.
What does favor neoplasm mean?
If after examining the tissue, your pathologist is still unable to decide the cause of the atypical glandular cells but thinks that the cells are most likely cancer cells, your report will also say "favor neoplasm". Neoplasm is word pathologists use to describe an abnormal growth of cells and is similar to the word tumour.
Why is this important? Atypical glandular cells is not a final diagnosis. It is a description of the cells seen on your Pap smear. Cancer is one possible reason for the atypical cells, but other non-cancerous causes are also possible.
After a diagnosis of atypical glandular cells, your doctor should plan to see you again within 6 months or should refer you to a specialist for additional tests. Depending on where you live, these additional tests may include:
Colposcopy – This procedure allows your doctor to see the entire outer surface of the cervix. During the colposcopy, the doctor will be looking for any areas that look abnormal on the surface of the cervix. If an abnormality is found, the doctor may decide to take a small sample of tissue called a biopsy to look for pre-cancerous and cancerous changes
Endocervical curetting – During this procedure the outside of the cervical canal is scraped using a spoon-shaped instrument called a curette. The sample is then examined under the microscope by a pathologist. The main purpose of this procedure is to show a presence of any abnormalities within the endocervical canal.
Endometrial biopsy – This procedure is performed to obtain a small tissue sample from the lining of the uterus, called the endometrium. The main purpose of this procedure is to show a presence of any abnormalities within the uterus.
Ultrasound – This procedure may be performed to look for abnormalities within either uterus or cervix. The ultrasound may be useful in detecting an increased thickening of the endometrium and/or presence of masses within the endometrial and endocervical cavity, and in the pelvis.
Why is this important? Compared to the Pap test, these tests take a closer look at your cervix and endometrium. They will help your doctors decide what caused the atypical glandular cells.