A 37-year-old woman with no history of abnormal Pap smears has a Pap smear showing atypical glandular cells. Which is the potential diagnosis and the next step?

• A. Ovarian cancer; CA-125
• B. Endometrial malignancy; colposcopy with endocervical curettage
• C. Cervical dysplasia; repeat Pap
• D. Pelvic inflammatory disease; antibiotics

Answer: (B)

Atypical glandular cells on a Pap smear point to possible glandular pathology arising from the endocervical canal or the endometrium, and these carry a higher concern for endocervical or endometrial neoplasia than squamous abnormalities. Because glandular changes can reflect early cancer or precancerous disease, the next step is a thorough evaluation with colposcopy to visualize the cervix and endocervical canal, plus endocervical sampling to obtain tissue for histology. In women around this age, it’s also prudent to sample the endometrium to assess for endometrial hyperplasia or carcinoma. That combination—colposcopy with endocervical curettage, with consideration of endometrial sampling if indicated—is why this approach is preferred.

This differs from options like a plan focused on ovarian cancer markers, which aren’t the initial concern raised by glandular cells on the Pap smear; or a plan for repeating the Papology aimed at squamous dysplasia, which wouldn’t address glandular lesions; or treating as pelvic inflammatory disease, which isn’t suggested by the cytology finding.