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.
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.
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.
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
Treatment and prognosis
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.
History and etymology
It is thought to have been first described by Gusserow in 1870 9.
Considerations for a cystic multilocular cervical lesion (especially on MRI) include:
- 1. Gilks CB, Young RH, Aguirre P et-al. Adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. A clinicopathological and immunohistochemical analysis of 26 cases. Am. J. Surg. Pathol. 1989;13 (9): 717-29. - Pubmed citation
- 2. Bin park S, Lee JH, Lee YH et-al. Multilocular cystic lesions in the uterine cervix: broad spectrum of imaging features and pathologic correlation. AJR Am J Roentgenol. 2010;195 (2): 517-23. doi:10.2214/AJR.09.3619 - Pubmed citation
- 3. Okamoto Y, Tanaka YO, Nishida M et-al. MR imaging of the uterine cervix: imaging-pathologic correlation. Radiographics. 23 (2): 425-45. doi:10.1148/rg.232025065 - Pubmed citation
- 4. Doi T, Yamashita Y, Yasunaga T et-al. Adenoma malignum: MR imaging and pathologic study. Radiology. 1997;204 (1): 39-42. Radiology (abstract) - Pubmed citation
- 5. Sugiyama K, Takehara Y. MR findings of pseudoneoplastic lesions in the uterine cervix mimicking adenoma malignum. Br J Radiol. 2007;80 (959): 878-83. doi:10.1259/bjr/16282081 - Pubmed citation
- 6. Granter SR, Lee KR. Cytologic findings in minimal deviation adenocarcinoma (adenoma malignum) of the cervix. A report of seven cases. Am. J. Clin. Pathol. 1996;105 (3): 327-33. - Pubmed citation
- 7. Tsuruchi N, Tsukamoto N, Kaku T et-al. Adenoma malignum of the uterine cervix detected by imaging methods in a patient with Peutz-Jeghers syndrome. Gynecol. Oncol. 1994;54 (2): 232-6. doi:10.1006/gyno.1994.1200 - Pubmed citation
- 8. Yamashita Y, Takahashi M, Katabuchi H et-al. Adenoma malignum: MR appearances mimicking nabothian cysts. AJR Am J Roentgenol. 1994;162 (3): 649-50. AJR Am J Roentgenol (citation) - Pubmed citation
- 9. Ki EY, Byun SW, Park JS et-al. Adenoma malignum of the uterine cervix: report of four cases. World J Surg Oncol.11 (1): 168. doi:10.1186/1477-7819-11-168 - Free text at pubmed - Pubmed citation
- 10. Park SB, Moon MH, Hong SR et-al. Adenoma malignum of the uterine cervix: ultrasonographic findings in 11 patients. Ultrasound Obstet Gynecol. 2011;38 (6): 716-21. doi:10.1002/uog.9078 - Pubmed citation