Adenoma malignum of the cervix, also referred to as minimal deviation carcinoma / minimal deviation adenocarcinoma, is considered a rare variant of cervical mucinous adenocarcinoma.
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Epidemiology
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.
Associations
Clinical presentation
Common presenting symptoms are menometrorrhagia, vaginal (often watery) discharge, postmenopausal bleeding and abdominal swelling.
Pathology
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 that are irregular in size and shape and lined predominantly by mucin-containing columnar epithelial cells with basal nuclei.
Radiographic features
Ultrasound
Enlarged globular cervix with multilocular cystic (grape-like clusters), multilocular cystic with solid components or predominantly solid on ultrasound. The solid lesions are usually heterogeneous in echogenicity. Color Doppler interrogation usually shows moderate or abundant color content 10.
MRI
May be seen as a multicystic 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 poor response to radiation and/or chemotherapy.
History and etymology
It is thought to have been first described by Gusserow in 1870 9.
Differential diagnosis
Considerations for a cystic multilocular cervical lesion (especially on MRI) include:
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pseudoneoplastic glandular lesions
tunnel cluster 5: usually shows no cervical enlargement, no solid component, no increased color Doppler flow and does not invade stroma
deep Nabothian cysts 5,8