Anatomic Pathology: Gynecologic Pathology

527) A 28-year-old woman undergoes a cervical biopsy after a Papanicolaou smear diagnosis of atypical glandular cells of undetermined significance. The histologic finding is shown. What is the diagnosis?

• Microglandular hyperplasia is a lesion most commonly seen in reproductive-age women. It is a reactive lesion of endocervical glands and must be differentiated from endocervical adenocarcinoma and well-differentiated endometrial adenocarcinoma.

• Pathologists need to be aware that p16 stains microglandular hyperplasia strongly, and it should not be assumed that this finding is related to human papillomavirus (HPV) infection.

• Uncommon histologic patterns of microglandular hyperplasia, such as solid sheets, hobnail cells, signet ring cells, and pseudoinfiltrative growth, can pose significant problems in the differential diagnosis.

• Oral contraceptive use and pregnancy are common clinical scenarios associated with microglandular hyperplasia.

• Although microglandular hyperplasia has been seen in postmenopausal women, endometrial carcinoma is more likely in this population. The diagnosis of microglandular hyperplasia should be made with caution in a postmenopausal patient.

Medeiros F, Bell DA: Pseudoneoplastic lesions of the female genital tract. Arch Pathol Lab Med 2010;134(3):393-403.

Roh MH, Agostin E, Birch C, et al: P16 immunohistochemical patterns in microglandular hyperplasia of the cervix and their significance. Int J Gynecol Pathol 2009;28(2):107-113.

 
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