title: Usefulness of a management protocol for patients with cervical multicystic lesions: A retrospective analysis of 94 cases and the significance of GNAS mutation.
abstract: OBJECTIVE
  The proper preoperative diagnosis and management of cervical proliferative disorders presenting with multiple cysts, including minimal deviation adenocarcinoma (MDA), lobular endocervical glandular hyperplasia (LEGH), and nabothian cyst (NC), have not been fully established. We previously proposed a management protocol comprising a diagnostic approach using cytology, magnetic resonance imaging, and gastric-type mucin and subsequent treatment. We herein evaluate the usefulness of this protocol and implications of GNAS mutations in LEGH.
  
  
  METHODS
  The clinical courses of 94 patients with cervical multicystic lesions who visited our hospital between June 1995 and September 2014 were retrospectively analyzed. GNAS mutations were investigated in 10 LEGH, five LEGH with atypia, and two MDA cases.
  
  
  RESULTS
  Of the 94 patients, the conditions of 10, 59, and 25 were clinically diagnosed as suspicious of MDA or carcinoma (S/O MDA-Ca), suspicious of LEGH (S/O LEGH), and NC, respectively. Ten patients each with S/O MDA-Ca and S/O LEGH underwent hysterectomy, and the correct ratio for diagnosis was 90% (18/20). Of the 42 S/O LEGH cases followed-up for more than 12 months, three showed an increase in tumor size. After hysterectomy, two were LEGH with atypia while one was NC. The GNAS mutation was detected in two cases of LEGH with atypia, one of which showed an increase in tumor size during follow-up.
  
  
  CONCLUSIONS
  The management protocol we propose herein will be useful. An increase in tumor size is important to detect potentially malignant LEGH. GNAS mutations may be involved in the tumorigenesis of potentially malignant LEGH.
authors.affiliation: Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ando
authors.affiliation: Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan. tmiya@shinshu-u.ac.jp.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Miyamoto
authors.affiliation: Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kashima
authors.affiliation: Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Takatsu
authors.affiliation: Division of Diagnostic Pathology, Okaya City Hospital, Okaya, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Fujinaga
authors.affiliation: Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Tanri
authors.initials: T
authors.lastname: Shiozawa
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000601:surgery*; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002864:Chromogranins / Q000235:genetics*; D019092:Conization; D005260:Female; D019205:GTP-Binding Protein alpha Subunits, Gs / Q000235:genetics*; D006801:Humans; D006965:Hyperplasia; D007044:Hysterectomy; D008875:Middle Aged; D009154:Mutation; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000601:surgery*
chemical_list: D002864:Chromogranins; C406732:GNAS protein, human; D019205:GTP-Binding Protein alpha Subunits, Gs
keywords: adenocarcinoma; follow-up studies; gastric mucins; mutation; uterine cervical neoplasms