Adenoma malignum of the cervix

Adenoma malignum of the cervix, also referred to as minimal deviation carcinoma / minimal deviation adenocarcinoma, is considered a rare variant of cervical carcinoma. It is thought to represent ~1-3% of all cervical adenocarcinomas.

It can present in a wide age group (~25-70 years) peaking at around 42 years 1.

Common presenting symptoms are menometrorrhagia, vaginal (often watery) discharge, postmenopausal bleeding and abdominal swelling.

It is considered a rare variant of well-differentiated mucinous adenocarcinoma of the uterine cervix. Multiple irregular lobulations of distorted glands demonstrating a "hairpin" shape are considered a characteristic pathological feature 5.

Microscopic examination often shows glands which are irregular in size and shape and lined predominantly by mucin-containing columnar epithelial cells with basal nuclei.

Associations
Ultrasound

Lesions can be multilocular cystic, multilocular cystic with solid components or predominantly solid on ultrasound. The solid lesions are usually heterogeneous in echogenicity. Colour Doppler interrogation usually show moderate or abundant colour content 10.

MRI

May be seen as multiple cystic lesion containing variably sized solid portions extending from the endocervical gland to the deep stroma of the cervix. 

Reported signal characteristics include

  • T1: isointense (majority) to slightly hyperintense relative to the uterus 4
  • T2: markedly hyperintense relative to the uterus 4
  • T1 C+ (Gd): solid components show contrast enhancement

The overall prognosis has been reported to be unfavorable due to dissemination into the peritoneal cavity even at an early stage of the disease due to response to radiation and/or chemotherapy being poor.

It is thought to have been first described by Gusserow in 1870 9.

Considerations for a cystic multilocular cervical lesion (especially on MRI) include:

Share article

Article Information

rID: 13399
System: Gynaecology
Tag: cases
Synonyms or Alternate Spellings:
  • Adenoma malignum
  • Minimal deviation adenocaricoma (MDA) of the cervix
  • Minimal deviation carcinoma of the cervix
  • Mucinous minimal deviation carcinoma of the cervix
  • Minimal deviation adenocarcinoma of the cervix

Support Radiopaedia and see fewer ads

Cases and Figures

  • Drag
    Case 1
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.