Lobular endocervical glandular hyperplasia is a metaplastic process with apyloric gland phenotype

Aims: Lobular endocervical glandular hyperplasia of the uterine cervix is a rare pseudoneoplastic lesion of the uterine cervix. described recently. Ou r aim was to characterize the clinicopathological and immunohistochemical f eatures of lobular endocervical glandular hyperplasia, to elucidate its pyl oric gland phenotype, and to distinguish it from adenoma malignum of the ut erine cervix. Methods and results: Nine cases of lobular endocervical glandular hyperplas ia were studied histologically and immunohistochemically. The average age o f the nine patients was 48.8 years (range 38-64 years). Six cases were foun d incidentally. whereas in three cases a watery vaginal discharge and imagi ng studies suggested adenoma malignum preoperatively. Microscopically, lobu lar endocervical glandular hyperplasia ranged from 1 mm to 20 rum (mean 6.8 mm) in the largest horizontal extent and 1 mm to 10 mm (mean 3.9 mm) in de pth. and was characterized by lobular arrangements of small glands composed of low columnar cells with pale eosinophilic cytoplasm and bland nuclei. T hree cases showed a pseudo-invasive growth. Intracytoplasmic mucin was pred ominantly PAS-positive, and seven cases showed immunoreactivity for M-CGMC- 1, an antibody that reacts with pyloric gland-type mucin. Only focal and fa int reactivity for CEA was seen, and ER was negative in all cases. The cyto keratin profile was CK7+/20- in all cases, in keeping with their Mullerian derivation. All three lesions examined contained chromogranin-positive endo crine cells, After surgery all patients are well without recurrent disease (mean follow-up was 48.4 months). Conclusions: Lobular endocervical glandular hyperplasia is a morphologicall y distinct pseudoneoplastic glandular lesion, which has unique phenotypic c haracteristics shared by pyloric glands of the stomach. Although most are f ound incidentally, some cases may show clinical and radiological features r esembling those of adenoma malignum.