Endocervical Glandular Hyperplasia (Diffuse and Lobular)



Endocervical Glandular Hyperplasia (Diffuse and Lobular)


Marisa R. Nucci, MD





Key Facts


Clinical Issues



  • Typically incidental finding


  • Excellent prognosis


  • If atypical features present in LEGH, may be associated with adenoma malignum


Microscopic Pathology



  • Diffuse laminar endocervical glandular hyperplasia



    • Usually inner 1/3 of cervical wall


    • Laminar proliferation of round to branching glands


    • Mild nuclear enlargement with nucleoli (reactive changes) associated with stromal chronic inflammation, the latter more pronounced at deepest interface


  • Lobular endocervical glandular hyperplasia



    • Usually inner half of cervical wall


    • Lobular proliferation of small to medium-sized rounded glands often centered around larger gland


    • Tall columnar mucinous epithelium with bland, basally located nuclei


  • LEGH with atypical features



    • Epithelial infolding or distinct papillary projections


    • Loss of nuclear polarity with budding or “exfoliation”


    • Nuclear enlargement with hyperchromasia and distinct nucleoli


    • Apoptotic bodies &/or luminal debris


    • Occasional apical mitoses


Top Differential Diagnoses



  • Minimal deviation adenocarcinoma (adenoma malignum)


  • Endocervical adenomyoma







Diffuse laminar endocervical glandular hyperplasia shows a band-like proliferation of irregularly shaped glands that have a sharply demarcated deep border. Note the associated inflammatory infiltrate.






Lobular endocervical glandular hyperplasia is characterized by a lobular proliferation of small to medium-sized round glands often centered around a larger gland with a clefted contour.


TERMINOLOGY



Abbreviations



  • Diffuse endocervical glandular hyperplasia (DEGH)


  • Lobular endocervical glandular hyperplasia (LEGH)



Definitions



  • Benign proliferation of endocervical glands




CLINICAL ISSUES


Presentation



  • Typically incidental finding


  • Vaginal (sometimes mucoid) discharge (LEGH)



Treatment



  • If atypical features present, complete excision to exclude coexistent malignancy


Prognosis



  • Excellent (DEGH, LEGH)


  • LEGH with atypical architectural or cytologic features may be associated with adenoma malignum, the latter associated with poor prognosis


MACROSCOPIC FEATURES


Diffuse Laminar Endocervical Glandular Hyperplasia



  • Typically no appreciable mass


Lobular Endocervical Glandular Hyperplasia



  • Often no gross lesion


  • Occasionally grossly visible, well-demarcated mass


MICROSCOPIC PATHOLOGY


Histologic Features



  • Diffuse laminar endocervical glandular hyperplasia



    • Usually inner 1/3 of cervical wall


    • Sharply demarcated deep border


    • Laminar proliferation of round to branching glands


    • Chronic inflammatory infiltrate, more pronounced at deepest interface


  • Lobular endocervical glandular hyperplasia



    • Usually inner half of cervical wall


    • Lobular proliferation of small to medium-sized rounded glands often centered around larger gland


    • No associated stromal response


  • LEGH with atypical features



    • Epithelial infolding or distinct papillary projections


    • Budding or “exfoliation” of cells


Cytologic Features

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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Endocervical Glandular Hyperplasia (Diffuse and Lobular)

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