Lobular endocervical glandular hyperplasia, not otherwise specified - A clinicopathologic analysis of thirteen cases of a distinctive pseudoneoplastic lesion and comparison with fourteen cases of adenoma malignum

We report 13 cases of a previously undescribed pseudoneoplastic lesion of t he uterine cervix, which we have designated "lobular endocervical glandular hyperplasia, not otherwise specified." The patients' ages ranged from 37 t o 71 years (mean, 45 years; median, 49 years). Three (27%) patients had a h istory of hormone use. Seven lesions were incidental findings in hysterecto my specimens. In the six other cases, the patient came to clinical attentio n because of a mucoid cervical discharge (two cases), increased vaginal dis charge (two cases), abdominal discomfort (one case), or a 3.5-cm cervical m ass found when being examined because of ovarian carcinoma (one case); hyst erectomy was performed in each of these six cases. Microscopic examination showed a distinctly lobular proliferation of small to moderately sized roun ded glands often centered around a larger central gland. The lobular prolif eration was well to poorly demarcated and usually confined to the inner hal f of the cervical wall. Glands within the lobules were usually separated fr om each other by unaltered or hypercellular cervical stroma and were lined by columnar mucinous cells similar to the normal endocervix. Occasional rea ctive atypia of the endocervical cells and mitoses were seen, but no signif icant cytologic atypia was identified. Neither of the two cases stained sho wed cytoplasmic immunoreactivity for carcinoembryonic antigen. Follow-up of seven patients showed no evidence of recurrence of the cervical lesion, wi th an average length of follow-up of 3.4 years; three patients were lost to follow-up and three cases are recent. The principal consideration in the d ifferential diagnosis was adenoma malignum (minimal deviation adenocarcinom a). The features most helpful in this distinction, in addition to the order ly lobular arrangement of the glands, were a lack of the following: irregul ar stromal infiltration, a desmoplastic stromal response, and focal maligna nt cytologic features. Lobular endocervical gland hyperplasia should be add ed to the list of previously described pseudoneoplastic glandular lesions o f the cervix and, like them, not misinterpreted as neoplastic.