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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
  1. Akiko Takatsu, MD*,
  2. Tanri Shiozawa, MD, PhD*,
  3. Tsutomu Miyamoto, MD, PhD*,
  4. Kazuko Kurosawa, MD, PhD*,
  5. Hiroyasu Kashima, MD, PhD*,
  6. Tomoko Yamada, MD*,
  7. Tsunehisa Kaku, MD, PhD,
  8. Yoshiki Mikami, MD, PhD,
  9. Takako Kiyokawa, MD, PhD§,
  10. Hitoshi Tsuda, MD, PhD,
  11. Keiko Ishii, MD, PhD,
  12. Kaori Togashi, MD, PhD#,
  13. Takashi Koyama, MD, PhD**,
  14. Yasunari Fujinaga, MD, PhD††,
  15. Masumi Kadoya, MD, PhD††,
  16. Akihiko Hashi, MD, PhD‡‡,
  17. Nobuyuki Susumu, MD, PhD§§ and
  18. Ikuo Konishi, MD, PhD∥∥
  1. *Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Asahi, Matsumoto;
  2. Department of Health Sciences, School of Medicine, Kyushu University, Fukuoka;
  3. Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto;
  4. §Department of Molecular Pathology, Graduate School of Medicine and School of Medicine, Chiba University, Chiba;
  5. Clinical Laboratory Division, National Cancer Center Hospital, Tokyo;
  6. Division of Diagnostic Pathology, Okaya City Hospital, Okaya;
  7. #Department of Radiology, Kyoto University Graduate School of Medicine, Kyoto;
  8. **Department of Radiology, Osaka Red Cross Hospital, Osaka;
  9. ††Department of Radiology, Shinshu University School of Medicine,Asahi, Matsumoto;
  10. ‡‡Obstetrics and Gynecology, National University Corporation University of Yamanashi, Yamanashi;
  11. §§Department of Obstetrics & Gynecology, School of Medicine, Keio University, Tokyo; and
  12. ∥∥Department of Gynecology and Obstetrics, Kyoto University Faculty of Medicine, Kyoto, Japan.
  1. Address correspondence and reprint requests to Tanri Shiozawa, MD, PhD, Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. E-mail: tanri{at}


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.

Abbreviations: MDA - Minimal deviation adenocarcinoma, LEGH - Lobular endocervical glandular hyperplasia, NC - Nabothian cyst, TC - Tunnel cluster, NILM - Negative for intraepithelial lesion, AGCs - Atypical glandular cells, AIS - Adenocarcinoma in situ, CPR - Central pathological review, Pap - Papanicolaou, MRI - Magnetic resonance imaging

  • Minimal deviation adenocarcinoma (MDA)
  • Lobular endocervical glandular hyperplasia (LEGH)
  • Gastric type mucin
  • Magnetic resonance imaging
  • Diagnosis

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  • The authors have no conflict of financial interest.

  • This work was supported in part by grants-in-aid for Scientific Research from the Ministry of Education, Science and Culture Japan (grant 07807154) and the Japan Society of Obstetrics and Gynecology.