BENIGN ENDOCERVICAL ADENOMYOMAS AND ADENOMA MALIGNUM

Ten benign biphasic cervical tumors that we have designated ''adenomyo mas of endocervical type'' are reported because they might be confused with adenocarcinoma The patients ranged from 21 to 55 years of age (m ean, 40 yr). Two presented with abnormal vaginal bleeding, but, in mos t patients, the cervical tumors did not cause symptoms. On physical ex amination or at operation, eight patients were found to have tumors ra nging from 1.3 to 8.0 cm in greatest dimension growing into the endoce rvical canal and, in three cases, prolapsing through the external os. The remaining two patients had mural tumors measuring 11.0 and 23.0 cm in greatest dimension, which projected into the pelvis from the outer aspect of the cervix, without mucosal involvement. The tumors were we ll circumscribed and grey-white or tawny, and five contained multiple mucin-filled cysts up to 3.0 cm in diameter, One tumor was focally hem orrhagic. On microscopic examination, the tumors were composed of glan ds and cysts lined by a single layer of endocervical-type mucinous epi thelium admired with smooth muscle. The epithelial component tvas typi cally composed of large irregularly shaped glands with papillary epith elial infolding, surrounded by smaller simple glands, frequently resul ting in a lobular arrangement Tubal-type epithelium was present focall y in six tumors and endometrial-type glands surrounded by endometrial stroma were present in one case. Both the epithelium and smooth muscle were uniformly bland, without significant mitotic activity, Five pati ents were treated initially by ''polypectomy.'' Hysterectomy 1 month a nd 1 year later in two of the cases revealed residual adenomyoma; a '' recurrence'' 3 years after polypectomy in another patient was treated by hysterectomy. In no case has there been evidence of spread beyond t he cervix The finding of a cervical tumor composed of bland, irregular ly shaped, mucinous glands surrounded by smooth muscle caused signific ant problems in differential diagnosis and a diagnosis of adenoma mali gnum was either favored or raised as a possibility by the initial path ologist in five of the cases. The gross circumscription of the adenomy omas, their polypoid appearance, the frequent lobular arrangement of g lands, the absence of invasive glands with a desmoplastic stromal reac tion, and lack of even focal atypia were the most helpful findings in differentiating these tumors from adenoma malignum.