New patterns of cellular presentation on cervical smears have become more frequent since the introduction of new sampling devices which provide increased material from the upper portions of the endocervical canal. The normal histologic variability of the endocervical canal, as well as the presence of tubal metaplasia, infectious and inflammatory reactions, squamous lesions involving endocervical glands, and true endocervical neoplastic lesions in these areas, have presented the cytologist with a variety of cellular appearances which may cause difficulties in differential diagnosis.
Recognition of these entities, their cytologic manifestations, and the effects of increased high endocervical sampling, will allow the cytologist to begin the process of gaining the experience necessary to assess these new cellular patterns. A potential management protocol for patient follow-up is presented which will allow the user to investigate such cases in an efficient and cost effective manner. © 1995 Wiley-Liss, Inc.