Adenoma malignum of cervix
Watery discharge per vagina. Lower abdominal discomfort.
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There is a large multicystic lesion in the cervix involving the entire stroma and projecting into the endocervical lumen. Post-contrast images show peripheral enhancement with multiple enhancing septations with central non-enhancing cystic areas. There are a few enhancing solid mural nodules as well. The lesion measures 5.8 × 3.6 × 5.1 cm. No significant extension into the uterine body. No extracervical extension. No infiltration into adjacent structures.
There are a few Gartner duct cysts in the vagina, largest septated cyst measuring 1.0 x 1.7 cm.
The uterus is retroverted with multiple fibroids. The fibroid in the anterior lower uterine corpus impinges on the junctional zone.
The sections of the cervix shows surface epithelium is squamous, glandular or both. The glandular epithelium resembles papillary endocervicitis. The glandular epithelium on the surface is tall columnar endocervical mucinous type with basally oriented regular nuclei with hardly any cytologic atypia. The glandular crypts are of varying sizes and shapes. These cysts are filled with mucin. There is no single cell tumour infiltration of the stroma. The glandular crypts are seen to extend into the outer third of the wall of cervix but there is no extracervical extension. The lesion extends from the endocervix to the transformation zone. The exocervix and endomyometrium are spared.
Diagnosis - Adenoma malignum (endocervical mucinous type).
Adenoma malignum is a rare subtype of cervical carcinoma.
Differentials for a multiloculated cystic lesion in the cervix:
- nabothian cysts / tunnel cluster
- endocervical hyperplasia
- no deep stromal involvement or solid component enhancement
Remember to screen the abdomen for intestinal polyps since adenoma malignum is associated with Peutz-Jeghers syndrome.
Special thanks to Dr HT Gururaj.