Introduction Lobular endocervical glandular hyperplasia (LEGH) is a rare benign disorder of the uterine cervix but it has the potential to develop into minimal deviation adenocarcinoma, which is a well differentiated form of gastric-type mucinous carcinoma. The differential diagnosis includes multiple cervical cystic lesions such as Nabothian cysts. A detailed workup for multiple cervical cystic lesions could help identify patients with the precursor lesions and treat accordingly before it transforms into a malignancy. An individualized preoperative workup and counselling was important to guide an appropriate management.

Methods A retrospective review in a regional tertiary gynaeoncology centre in Hong Kong was conducted between 2019 to 2020. Total of 797 case records were included. Three women were diagnosed to have lobular endocervical glandular hyperplasia after hysterectomy. Their clinical characteristics and preoperative imaging findings were analysed.

Results The mean age at diagnosis was between the range of 47–57 years old. One was pre-menopausal and two were menopaused. One woman presented with intermenstrual bleeding, one woman presented with watery vaginal discharge and one woman was diagnosed LEGH after hysterectomy for leiomyomas. Preoperative workups included physical examination, ultrasonography and MRI.

Conclusion/Implications Lobular endocervical glandular hyperplasia is a rare benign condition of the endocervix. The presentation ranged from asymptomatic to troublesome watery vaginal discharge and abnormal vaginal bleeding. It is crucial to have a systematic workup and detailed counselling for appropriate management before it transforms into the malignant condition of a minimal deviation adenocarcinoma.