Very interesting case. I showed the photos to Dr. Austin (he is our director of cytopathology and previous president of American Society of Cytopathology) and other cytopathologist. All of our three have similar oppinion.

1. We cannot report malignant,adenocarcinoma, or HSIL, based on the cytology above.

2. These cells look like endometrial cell orgin

3. Agree with Dr. Yu these cells mostly are endometrial cells from low uterin segment due to the sampling. There is mild cytologic atypia in  high power.  Few cells are large than others (two times)---pleomorphism.

The question is what we should call, endometrial cells in 绝经 (even though mostly the presence of the cells were due to the sampling) or atypical glandular cells.

The bottomline is that the women should have tissue sampling. Based on ASCCP guidline the women should have tissue sampling even we report normal endometrial cells in 绝经 women.

I may call normal endometrial cells if I take the test.

We all three  agree to call atypical glandular cells for this true clinical practice. I hope to make sure the women get tissue sampling, even though the result turns out to be negative in histologic specimen. Remember that 70-80% of women with AGC Pap will have no any endometrial or endocervical lesions in histologic follow-up. Also the diagnosis of endometrioid adenocarcinoma in histology is often based on the architecture, but not cytology. 

I did a lot AGC study and reviewed many AGC slides and have three publications in AGC. The more I study, the more I am confuded.

Just for your reference.

我高度怀疑为腺癌（子宫内膜来源极大），期待楼主公布最终结果。

 小荷姐姐，能不能多提供点正常细胞的图片；需要对照。

就以上图片而言个人认为恶性肿瘤细胞是肯定的了；现在需要做的是来源问题和原发部位的问题。

谢谢喻老师这么快的回帖，其实我第一次回帖的时候：直接考虑的是非角化鳞状细胞癌；但是感觉不妥。其实这个高核浆比成团细胞的鉴别诊断问题。我个人考虑有以下几个鉴别：

1、腺癌

2、非角化鳞状细胞癌

3、小细胞癌

4、子宫内膜

5、HSIL

6、其他

不过我个人认为最可能的还是前面三种情况。