Minimal deviation adenocarcinoma

Topic Completed: 1 February 2016

Revised: 28 December 2018, last major update February 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Minimal deviation adenocarcinoma [title]

Ashwyna Sunassee, M.D.
Ryan W. Askeland, M.D.
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Cite this page: Sunassee A. Minimal deviation adenocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cervixadenomamalignum.html. Accessed September 18th, 2019.
Definition / general
  • Endocervical adenocarcinoma which is mucinous and well differentiated, consisting of an endocervical glandular hyperplasia of lobular architecture resembling glands but with the characteristics of adenocarcinoma (Taiwan J Obstet Gynecol 2015;54:447)
  • Usually HPV negative (Mod Pathol 1998;11:11)
  • Often missed by small cervical biopsies
  • May have worse prognosis due to difficulty of diagnosis or discovery at higher stage with nodal involvement
  • Also called adenoma malignum
Essential features
  • 1 - 3% of endocervical adenocarcinoma
  • Rare and easily misdiagnosed
  • Diagnostic challenge due to its benign appearing histological characteristics
  • Consider in patients presenting with heavy vaginal discharge, cystic lesion on imaging, and atypical glandular cells on cytologic smear
  • Associated with Peutz-Jeghers syndrome with mutations in STK11 gene (Oncol Lett 2013;6:1184)
  • Rare
  • 1 - 3% of all cervical adenocarcinomas
  • Usually sporadic, but also associated with Peutz-Jeghers syndrome (rare, autosomal dominant disorder of hamartomatous polyposis in GI tract, mucocutaneous pigmentation and predisposition to benign and malignant GI, breast, ovary, cervix and testicular tumors)
  • Associated with STK11 gene mutations (Virchows Arch 2013;462:645)
  • Not related to HPV (Int J Gynecol Pathol 2005;24:296)
Clinical features
Radiology description
  • Diagnosis with MRI and ultrasonography is often difficult due to benign appearance
  • Transvaginal sonography can detect presence of multilocular cystic masses in the cervix and may aid in diagnosis
  • Ultrasound imaging with Doppler examination is more efficient and accurate
    • MDA has increased intralesional vascularity
  • MRI: multiple irregular cystic lesions, cysts arranged in floret-like manner with aggregates of small cysts resulting in a "cosmos pattern" (Int J Gynecol Cancer 2011;21:1287)
Case reports
Gross description
Gross images

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Tumor specimen

Microscopic (histologic) description
  • Well spaced, deeply invasive, branching glands lined with minimal cytological atypia and a focal stromal reaction (Pathology 1997;29:17, Mol Clin Oncol 2013;1:833)
  • Very well differentiated glands (usually endocervical type) with cystic dilation
  • Glands are variable in shape or size with irregular or claw shaped outlines with haphazard arrangement (Mol Clin Oncol 2013;1:833)
  • Often glands are close to thick walled vessels or within thickness of vessel wall (Int J Gynecol Pathol 2005;24:125)
  • May have vascular or perineural invasion
  • Rarely has endometrioid histology
Microscopic (histologic) images

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Endocervical type

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Nonspecific type

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Endometrioid-type glands deep in cervix

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Various images

Cytology description
  • Glandular cells showing nuclear crowding and clearing with gland opening or acinar-like pattern
  • Frequent appearance of large sheets of cells with a honeycomb pattern and a palisading arrangement at the periphery
  • Individual tumor cells are monomorphic, round or oval, with nonvacuolated cytoplasm with cytoplasmic extensions or tails, prominent and displaced hyperchromatic nuclei with chromatin clumping (Taiwan J Obstet Gynecol 2015;54:447)
  • Smear background shows variable necrotic debris and neutrophils in some cases (Diagn Cytopathol 2006;34:119)
  • No pleomorphism, no/rare mitotic figures (Am J Clin Pathol 1996;105:327)
  • Yellowish-orange staining of cytoplasmic mucins by the Papanicolaou method is an important diagnostic clue to identify mucinous MDA by cytology
  • Immunostaining with HIK1083 is useful (Cancer 1999;87:245)
Cytology images

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Positive stains
Molecular / cytogenetics description
Electron microscopy description
Differential diagnosis
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