Minimal Deviation Adenocarcinoma and Its Mimickers: A Case Report with Review of Literature

Amongst all the glandular lesions of the cervix, minimal deviation adenocarcinoma (MDA) the, so called Adenomamalignum and its mimickers have been the subject of great interest in the literature. Although a rare entity, MDA commonly requires consultancy to distinguish it from many benign cervical glandular lesions. MDA is a unique neoplasm of the uterine cervix, characterized by mucinous glands with deceptively benign histological appearance posing difficulty in its diagnosis. In the present case report MDA was an incidental finding in a 45-year-old female, on the hysterectomy specimen submitted for multiple leiomyomas, and the diagnosis was based on histopathological and immunohistochemical findings. *Corresponding author: Dr. Savita Agarwal, Amar Nath Dal Mill Azad Road Bahraich U.P. 271801 Phone: +91-9582036731 E-mail: [email protected] Case Report C-90 Minimal Deviation Adenocarcinoma Annals of Pathology and Laboratory Medicine, Vol. 02, No. 02, April June 2015 Introduction Amongst all the glandular lesions of the cervix, minimal deviation adenocarcinoma (MDA) the, so called Adenomamalignum and its mimickers have been the subject of great interest in the literature. Although a rare entity, MDA commonly requires consultancy to distinguish it from many benign cervical glandular lesions. MDA is a unique neoplasm of the uterine cervix, characterized by mucinous glands with deceptively benign histological appearance posing difficulty in its diagnosis. In the present case report MDA was an incidental finding on the hysterectomy specimen submitted for multiple leiomyomas, and the diagnosis was based on histopathological and immunohistochemical (IHC) findings. Case Report A 45 year old female presented with abnormal uterine bleeding, on clinical examination uterus was enlarged and cervix appeared normal. USG revealed multiple leiomyomas. Total abdominal hysterectomy without bilateral salphingoophrectomy was performed for leiomyomas and specimen was submitted for histopathological examination. Gross examination showed multiple leiomyomas and cervix was firm but otherwise unremarkable. Entire cervix was processed for microscopic examination. Low power microscopic examination of the sections from cervix showed proliferation of normal looking endocervical glands deeply infiltrating the underlying stroma. The glands extended into the endocervical stroma beyond the depth of 7mm from the surface, but remained confined to the cervix and no spread to parametrium or myometrium was noted. Glands were closely spaced and varied markedly in size and shape. Some glands were angulated and showed abnormal out pouching (Fig: 1). Glands were lined by innocuous appearing mucin containing columnar epithelial cells with basal nuclei and inconspicuous nucleoli. Desmoplastic stroma was present around some glands (Fig: 2). However no mitoses, no vascular, perineural invasion and obviously dysplastic or malignant glands were identified. Possibility of endocervical gland hyperplasia, florid deep gland and MDA were considered. A panel of IHC markers including ER (Estrogen Receptor), PR (Progesterone Receptor), CA-125 and CEA (Carcinoembryonic Antigen) was used and findings were compared with normal endocervical glands and Fig. 1: MDA: Endocervical glands of varying shape & sizes deeply infiltrating cervical stroma (H/E 40X) Fig. 2: MDA: Glands lined by bland appearing columnar cells with mild atypia (H/E 400X) Fig. 3: MDA: Another focus of neoplastic endocervical glands deeply infiltrating cervical stroma (H/E 100X)