*3.1. Clinical Features*

None of the women reported suspicious symptoms, such as vaginal bleeding or discharge. Almost all cases were detected by abnormal glandular cytology. An HPV DNA test resulted negative in all patients. Endometrial biopsy and transvaginal ultrasound ruled out the origin of abnormal glandular cells from endometrium, ovary and Fallopian tube in all cases. *Diagnostics* **2023**, *13*, 464 7 of 12 *3.1. Clinical Features*  None of the women reported suspicious symptoms, such as vaginal bleeding or dis‐ charge. Almost all cases were detected by abnormal glandular cytology. An HPV DNA test resulted negative in all patients. Endometrial biopsy and transvaginal ultrasound

#### *3.2. Cytology* ruled out the origin of abnormal glandular cells from endometrium, ovary and Fallopian tube in all cases.

Liquid-based cervical cytology revealed the presence of atypical or frankly malignant glandular cells in eight out of nine cases affected by CV localization of vulvar EMPD. The Paget cells were round to columnar with an increased nuclear/cytoplasmic (N/C) ratio and vacuolated cytoplasm. Since HER2 is frequently expressed in genital and anal EMPD (15–60% of cases) [8], a cell block was set-up with residual cellularity and HER2 expression explored by immunocytochemistry in four cases in order to support the diagnosis (Figure 3). *3.2. Cytology* Liquid‐based cervical cytology revealed the presence of atypical orfrankly malignant glandular cells in eight out of nine cases affected by CV localization of vulvar EMPD. The Paget cells were round to columnar with an increased nuclear/cytoplasmic (N/C)ratio and vacuolated cytoplasm. Since HER2 is frequently expressed in genital and anal EMPD (15– 60% of cases) [8], a cell block was set‐up with residual cellularity and HER2 expression explored by immunocytochemistry in four cases in order to support the diagnosis (Figure 3).

**Figure 3.** Cervical cytology of EMPD: (**a**,**b**) liquid‐based cytology; (**c**,**d**) cell block. Note the (arrow) Paget cells as round or columnar cells with an increased N/C ratio (a, 20×), arranged in small clusters (b, 40×) on liquid‐based cytology and highlighted on the cell block (c, 20×) by HER2 expression (d, 20×). *3.3. Colposcopy* Colposcopy with endocervical curettage and guided ectocervical and/or vaginal bi‐ **Figure 3.** Cervical cytology of EMPD: (**a**,**b**) liquid-based cytology; (**c**,**d**) cell block. Note the (arrow) Paget cells as round or columnar cells with an increased N/C ratio (**a**, 20×), arranged in small clusters (**b**, 40×) on liquid-based cytology and highlighted on the cell block (**c**, 20×) by HER2 expression (**d**, 20×).

opsies was performed in all patients diagnosed with atypical glandular cells on pap smear in order to assess the nature of the atypical cells, the extent of the disease and make the

ever, some cases showed dense acetowhite epithelium with a sharp border, whereas other

The colposcopic findings were heterogeneous in our CV localizations of EMPD and

best therapeutic decision.
