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 mucinous adenocarcinoma

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.

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 show moderate or abundant color 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

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:

Article information

rID: 13399
System: Gynaecology
Tag: cases, 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

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Cases and figures

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