Exfoliative cytology of atypical polypoid adenomyoma - A case report

BACKGROUND: An atypical polypoid adenomyoma (APA) is a well-defined entity. I occurs in the en dometrium, lower uterine segment and endocervix. It is usually composed of atypical complex glands with squamous metaplasia admire d with myofibromatous stroma. CASE: A 35-year-old female presented with one-year history of irregular men strual periods. A diagnosis of adenocarcinoma in situ was rendered on her c ervicovaginal smear. Pelvic examination revealed an enlarged uterus due to a leiomyoma. Colposcopic examination revealed a 0.6-cm, sessile, polypoid m ass at the junction of the endocervix and ectocervix. A cone biopsy of the lesion showed irregular, endometrial-type glands embedded in a prominent my ofibromatous stroma. The atypical glandular component of the mass demonstra ted varying degrees of architectural complexity, ranging from simple to com plex hyperplasia. In tissue sections the lesion was diagnosed as APA of the cervix. The patient underwent a hysterectomy for the leiomyoma. The hyster ectomy specimen showed an 8.5-cm leiomyoma. The cervix and uterine corpus r evealed no residual APA. CONCLUSION: APA of the cervix should be considered among the differential d iagnoses of atypical glandular cells of undetermined significance. The diag nosis of APA cannot be made on cytology; the final diagnosis requires histo logic confirmation.