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Objective: To determine the incidence and the association between atypical glandular cells (AGC) reported on cervical pap smears and the underlying malignant and pre-malignant genital tract pathology., Methods: A retrospective study was performed on the files of women who were had attended our colposcopy clinic at King Hussein Medical Centre (KHMC), between April 2014 and April 2018. Out of 8483 cervical pap smears reviewed, 68 patients have smears reported to be atypical glandular cells of undetermined significance (AGUS). Proper evaluation and follow up was available for 62 patients by performing colposcopic examination, repeating pap smear, proper biopsies and histological results. The factors considered included patients age, parity, symptoms, presence of pregnancy, smoking habits, hormonal therapy usage, colposcopic finding, and histological results of biopsies performed. Data were analyzed and comparison was performed between malignant and pre-malignant lesions., Results: 68 cases of AGUS pap smears were identified out of 8483 cases reviewed forming incidence of about (0.8%). Of 62 patients with AGUS pap smears, twenty-two cases (32.3%) were found to have clinically significant malignant lesions on subsequent histological follow up. It included 12 cases of endometrial adenocarcinoma, 5 cases of adenocarcinoma of cervix, 3 cases of squamous cell carcinoma of cervix and 2 cases with secondary metastasis to vagina. Of the 62 patients with AGUS pap smears, fourteen cases (20.6%) were found to have pre-malignant lesions. This included 7 cases of endometrial hyperplasia, 3 cases of adenocarcinoma in situ of cervix (ACIS) and 4 cases with cervical squamous intra-epithelial lesions. Abnormal vaginal bleeding was the most common presenting symptom (30.6%); Woman above the age of 40 years and especially post-menopausal were more likely to have significant histological abnormalities., Conclusion: Though the incidence of AGUS is low, it still important and clinically significant due to high substantial risk of having underlying premalignant or malignant lesions. Colposcopy and directed biopsy, endo-cervical curettage and endometrial biopsy should be performed to all women with AGUC especially to those above the age of 40 years, menopause, or having abnormal vaginal bleeding.

Objective: The aim of our study was to analyze the clinical and pathological characteristics of women who were diagnosed with malignant ovarian granulosa cell tumors and managed at single institution., Materials and Methods: A retrospective study was conducted regarding patients who were diagnosed with ovarian granulosa cell tumors and received treatment at King Hussein Medical Center. Data was extracted from the patient's files and reports from the period 2007 to 2017 (over ten years period). The collected data included patient's characteristics for age, parity, presenting symptoms, marital and menopausal status. Tumor characteristics included the site, size, mitotic index, type and associated uterine pathology. Other data included the type of surgery performed, adjuvant treatment provided, outcome data regarding tumor stage, recurrence and survival. Data was revised, arranged in tables and statically analyzed., Results: Twenty-one cases of ovarian granulosa cell tumors were identified. The median age of cases was 45.5 years (range of 17-76). Abdominal pain was the most common presenting symptom11/21 (52.4%). Endometrial hyperplasia was associated with ovarian tumor in six patients (28.6%) and endometrial cancer in three cases (14.3%). The primary surgery ranged from unilateral cystectomy to hysterectomy, bilateral salpingooophorectomy, and debulking surgery. Stage I-II were recorded in 18/21 (85.7%) of the cases, while stage III-V were found in 3/21 (14.3%). No adjuvant treatment was required in 11 cases (52.4%). Less than five years survival was 19% (4/21). Over all recurrence rate was 23.8%., Conclusion: Granulosa cell tumors is a rare ovarian malignancy. Surgery is the standard treatment with a role for fertility preservation. Most tumors are diagnosed at an early stage with very good outcomes. Recurrence and survival are related mainly to initial tumor stage, however, further studies are needed to study the effect of other factors on outcome.