Florid endocervical glandular hyperplasia with intestinal and pyloric gland metaplasia: Worrisome benign mimic of "adenoma malignum"

We describe three cases of florid endocervical glandular hyperplasia with i ntestinal and pyloric gland metaplasia, which can be a benign mimic of aden oma malignum. In two cases, adenoma malignum was seriously considered preop eratively because of watery vaginal discharge and the results of imaging st udies. The three cases shared common histopathological features, i.e., (i) proliferating endocervical glands surrounded by clusters of smaller glands, resembling the pyloric glands of the stomach; (ii) occasional intestinal m etaplasia; (iii) bland nuclear features: and (iv) predominantly PAS-positiv e neutral mucin in the glandular epithelium. In two cases, glands were dens ely and irregularly arranged in some areas. Immunohistochemistry disclosed that the intracytoplasmic mucin of the metaplastic epithelium was positive for M-GGMC-1 (HIK1083), which reacts with mucin of pyloric glands. Monoclon al CEA was negative in all cases. This pseudoneoplastic benign condition sh ould be recognized by both gynecologists and pathologists, although it migh t be difficult to establish definite diagnosis preoperatively even with dee p cone biopsy. (C) 1999 Academic Press.