This article will help you read and understand your Pap test report for atypical glandular cells.
by Adnan Karavelic MD FRCPC, updated December 22, 2020
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.
Atypical glandular cells can come from either the endocervical glands or the endometrial glands.
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.
A normal Pap test will show mostly squamous cells although it is normal to find small groups of glandular cells from the endocervix. Some Pap tests 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 test from a postmenopausal woman is considered abnormal. For these women, an endometrial biopsy is recommended to investigate the source of the 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 is able to determine where the cells come from, it will be described in your report. An atypical glandular cells result means that your pathologist was unable to tell if the cells came from the endocervix or the endometrium.
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.
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.
Atypical glandular cells is a preliminary result. It is not a final diagnosis. Rather, it is a description of the cells seen on your Pap test. Cancer is one possible reason for the atypical cells, but other non-cancerous causes are also possible.
After an atypical glandular cells result, 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:
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.