title: Preoperative differential diagnosis of minimal deviation adenocarcinoma and lobular endocervical glandular hyperplasia of the uterine cervix: a multicenter study of clinicopathology and magnetic resonance imaging findings.
abstract: OBJECTIVE
  To clarify the preoperative differential diagnosis and management of minimal deviation adenocarcinoma (MDA) and lobular endocervical glandular hyperplasia (LEGH), a multicenter study was performed.
  
  
  METHODS
  A total of 112 patients who underwent conization or a hysterectomy for suspected MDA were collected from 24 hospitals. The pathological diagnosis in each case was determined by a central pathological review board. The diagnostic significance of clinicopathologic findings including results of magnetic resonance imaging (MRI), Papanicolaou (Pap) smears, and testing for gastric mucin was analyzed.
  
  
  RESULTS
  The central pathological review identified 37 cases of Nabothian cyst or tunnel cluster, 54 cases of LEGH, 6 cases of MDA, 11 cases of adenocarcinoma, and 4 cases of benign disease. Lobular endocervical glandular hyperplasia was often associated with adenocarcinoma in situ, MDA, and mucinous adenocarcinoma. Three MDA patients had a recurrence, whereas none of LEGH patients had a recurrence irrespective of the type of surgery. On MRI, LEGH appeared as a characteristic multicystic lesion with an inner solid component, whereas MDA showed a predominantly solid pattern. A Pap smear or gastric mucin alone had limited diagnostic power. However, a combination of these findings is useful; that is, a cystic structure with inner solid components on MRI associated with mild glandular atypia and gastric mucin strongly suggested LEGH (24/26, 92%). A solid structure with atypical glandular cells was indicative of MDA or adenocarcinoma (5/5, 100%).
  
  
  CONCLUSIONS
  The combination of MRI, Pap smears, and gastric mucin will improve the accuracy of the preoperative diagnosis of MDA and LEGH. Patients suspected of having LEGH may need to be treated with less aggressive methods.
authors.affiliation: Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Asahi, Matsumoto, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Takatsu
authors.forename: Tanri
authors.initials: T
authors.lastname: Shiozawa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Kazuko
authors.initials: K
authors.lastname: Kurosawa
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kashima
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yamada
authors.forename: Tsunehisa
authors.initials: T
authors.lastname: Kaku
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Mikami
authors.forename: Takako
authors.initials: T
authors.lastname: Kiyokawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsuda
authors.forename: Keiko
authors.initials: K
authors.lastname: Ishii
authors.forename: Kaori
authors.initials: K
authors.lastname: Togashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Koyama
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Fujinaga
authors.forename: Masumi
authors.initials: M
authors.lastname: Kadoya
authors.forename: Akihiko
authors.initials: A
authors.lastname: Hashi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Susumu
authors.forename: Ikuo
authors.initials: I
authors.lastname: Konishi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D005752:Gastric Mucins / Q000032:analysis; D006801:Humans; D006965:Hyperplasia; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D065006:Papanicolaou Test; D011300:Preoperative Care; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears
chemical_list: D005752:Gastric Mucins