Microglandular hyperplasia refers to polypoid cell growth in the adenocarcinoma of the cervix. Measuring about 1 to 2 cm, the glandular lesions normally occur in pregnant or postpartum women on oral contraceptive therapy, clinically referred to us Depomedroxyprogesterone acetate. These lesions mostly occur in women of productive age and a few cases in postmenopausal women.
According to Medeiros and Bell, microglandular hyperplasia cells can described as “tightly packed glandular units, lined with epithelium cells that consists of eosinophilic granular cytoplasm containing quantities of mucin” (1). Microscopically, nuclei appear vesicular and are uniform in pattern while the mitotic figures are rare.
Microglandular hyperplasia patters can be confusingly similar especially in the benign endocervical glandular proliferation and adenocarcinoma formation in the endocervical and endometrial. These close resemblances often pose a diagnostic challenge both clinically and pathologically since they resemble malignant cells.
Medeiros and Bell in their clinical studies characterise microglandular hyperplasia cells to present either polyp or erosion lesion, appear in singular forms or multifocal and sometimes located deeply or superficially.
Histologically, an extreme variety of patterns with unusual regularity and uniformity are often cited in their closely packed, small tubular with areas of cystic dilatation which are sometimes acute and other times chronic inflammation typically associated with the lesions present within luminal secretions. Cytoplasm contains subnuclear clear values while the nuclei are deceptively bland in nature and present rare mitotic figures (1)
The unusual microglandular hyperplasia patterns that pose diagnostic challenges are stated by Medeiros and Bell as “solid, sheetlike proliferation of cells, pseudoinfiltrate growth, signet ring cells, hobnail-like cells, increased nuclear atypia and mitotic figures”(1).
Usually, the difficult distinction between endocervical microglandular hyperplasia and endometrial adenocarcinoma in biopsy is the major reasons why a patient should see a gynaecological pathologist.
Padrao and Andrade replicated this studies by adding that florid microglandular hyperplasia presents itself in pregnant women with Aria-Stella reaction, which is a closely simulated adenocarcinoma and emerge in areas of microglandular hyperplasia (2).
Microglandular hyperplasia cells originate from hormonal stimulation in the female genital tract and may sometimes accumulate on non-detectable levels. They act on cellular proliferation that may sometimes mimic malignant tumours, but their morphologic features distinguish them from other proliferative processes.
Pathology of microglandular hyperplasia occurs as a result of hormonal pregnancy changes in the ovarian cells resulting to pregnancy luteoma and large solitary luteinised follicular cysts pregnancy and puerperium. Due to hyperplasic changes in the endometriosis and the pregnancy changes in ovary, early diagnosis is critically important to prevent overtreatment in young women with reproductive (1, 3).
It’s clinically proven that mucinous can either be pure or intermixed with endometrioid adenocarcinoma. Sometimes the age of a patient may pose a challenge when doing a diagnosis and is, however, recommended to exercise extreme caution when doing a diagnosis of microglandular hyperplasia of older patients.
Conclusively, it’s further recommended that any traces of mild nuclear atypia or even mitotic activity in a postmenopausal woman should prompt for further investigation (1, 3).
Conclusion
Cervical changes in pregnant women as a result of microglandular hyperplasia should carefully be diagnosed to avoid overtreatment.
Although the differentiation between endocervical microglandular hyperplasia and endometrial adenocarcinoma often pose challenges, a well-sampled specimen will help facilitate correct diagnosis. The hyperplasic changes in the endometriosis and the pregnancy changes in ovary require early diagnosis to prevent overtreatment in young women.
Bibliography
- Medeiros, F., & Bell, DA. Seudoneoplastic Lesions of the Female Genital Tract. Archives Pathology Lab Med 2010;134:393-403
- Laura J. Yahr, M D., Kenneth R. Lee, M D. Diagnostic Cytopathology: Cytologic findings in microglandular hyperplasia of the cervix. Wiley-Liss Inc 2006; 7 (3): 248-251
- Padrad, I L., & Andrade, LA. Microglandular hyperplasia of the cervix frequency in cone specimens, histological patterns, clinical aspects and immunohistochemical marlers for differential diagnostic with adenocarcinoma. Brad Patol Med Lab 2006; 42 (3): 219-225.