Sabato 27 ottobre 2012 - Pacini Editore

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at hysterectomy. The cut surface was solid, whitish to yellowish,
and contained some cystic spaces filled with clear mucus.
Microscopically, the tumor was composed of glands (Fig. 3)
and cysts lined by a single layer of endocervical-type mucinous
epithelium with eosinophilic and ciliated metaplasia and admixed
with smooth muscle. The glands showed focal pseudopapillary
growth. There was no distinct nuclear atypia in the proliferating
glands, there were no architectural abnormalities and there was
no evidence of destructive stromal invasion by the epithelial
component, including an absence of periglandular desmoplastic
response. Foci of periglandular chronic inflammation were
present. Less than five mitotic figures per 10 high-power-fields
were present in the smooth muscle component. Immunohistochemically,
smooth muscle was positive for desmin and smooth
muscle actin and was negative for CD10.
Conclusions. Endocervical adenomyoma is a rare benign neoplasm
with glandular as well as stromal proliferation. The differential
diagnosis includes a variety of lesions in the region,
most of which are benign pseudoneoplastic processes. These
lesions include deep endocervical glands or cysts, microglandular
hyperplasia, tunnel clusters (a tightly packed group of dilated endocervical
glands with flattened epithelium), lobular endocervical
glandular hyperplasia and diffuse laminar endocervical gland hyperplasia
5 6 . These lesions do not have the smooth muscle proliferation
seen in endocervical adenomyoma, but consist of glands
in normal or hyperplastic cervical stroma. Another benign lesion
that has characteristics similar to adenomyoma is endocervicosis:
the glands, often cystically dilated, are lined by mucinoid-type
endocervical cells and typically occupy the outer one-third of the
cervical wall with extension to the paracervical tissues. The most
clinically important distinction is from an adenoma malignum
of the uterine cervix, and this may pose a diagnostic problem.
Figg. 1, 2. transvaginal ultrasound. 1. (left) the uterine cervix appeared
increased in volume and deformed in its morphology due to the
presence of a mixed (solid and cystic) lesion in ill-defined margins, a
diameter of about cm 4, in part projecting into the endocervical canal
and in part infiltrating the endocervical stroma (the arrow indicates
the endocervical canal). 2. (Right) the lesion had two components: a
solid homogeneous hyperechoic (white arrow) and a cystic vacuolar
(red arrow).
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
Figg. 3, 4. EE, 10x. 3.(left) the glands are coated by a single layer of
endocervical-type mucinous epithelium admixed with smooth muscle.
4. (Right) Smooth muscle proliferation.
Figg. 5, 6. 5. (left) desmin, 10x. muscle fibers surrounding an endocervical
gland. 6. (Right) Ki-67, 20x. lack of replicative activity in the
glandular and muscolar component.
Clinical manifestations of mucoid vaginal discharge and the existence
of florid glandular proliferations extending deep into the
cervical stroma are of diagnostic help. The histologic features are
glands with deceptively benign histological appearance. It also
may grow within the cervix and may not be obvious at clinical
vaginal inspection. Despite its benign appearance, it may carry a
poor prognosis.
Of the few reported cases of endocervical adenomyoma, most
are isolated reports 7 8 . The largest series reported was in 1996 by
Gilks et al. 3 , who reported on 10 cases in women ranging from