Microglandular hyperplasia
Microglandular hyperplasia (MGH) of the cervix is an epithelial (endocervical mucosa) benign abnormality (lesion) associated with gland proliferation.{{cite journal|vauthors=Daniele E, Nuara R, Morello V, Nagar C, Tralongo V, Tomasino RM | title=[Micro-glandular hyperplasia of the uterine cervix. Histo-cytopathological evaluation, differential diagnosis and review of literature]. | journal=Pathologica | year= 1993 | volume= 85 | issue= 1100 | pages= 607–35 | pmid=8170711 }} It can terminate in mature squamous metaplasia, and it is suspected reserve cells are involved in this process, perhaps in the form of reserve cell hyperplasia with glandular differentiation.{{cite journal|vauthors=Witkiewicz AK, Hecht JL, Cviko A, McKeon FD, Ince TA, Crum CP | title=Microglandular hyperplasia: a model for the de novo emergence and evolution of endocervical reserve cells. | journal=Hum. Pathol. | year= 2005 | volume= 36 | issue= 2 | pages= 154–61 | pmid=15754292 | doi=10.1016/j.humpath.2004.10.017 }}{{cite journal|vauthors=Chumas JC, Nelson B, Mann WJ, Chalas E, Kaplan CG | title=Microglandular hyperplasia of the uterine cervix. | journal=Obstet Gynecol | year= 1985 | volume= 66 | issue= 3 | pages= 406–9 | pmid=4022499 }}{{cite journal |vauthors=Martens JE, Smedts F, van Muyden RC, Schoots C, Helmerhorst TJ, Hopman A, etal | title=Reserve cells in human uterine cervical epithelium are derived from müllerian epithelium at midgestational age. | journal=Int. J. Gynecol. Pathol. | year= 2007 | volume= 26 | issue= 4 | pages= 463–8 | pmid=17885499 | doi=10.1097/pgp.0b013e31803c7c18 | s2cid=19701214 }}{{cite journal|last1=Alvarez-Santín|first1=Carmen|last2=Sica|first2=Adela|last3=Rodríguez|first3=María Carmen|last4=Feijó|first4=Alicia|last5=Garrido|first5=Grisel|title=Microglandular Hyperplasia of the Uterine Cervix|journal=Acta Cytologica|volume=43|issue=2|year=1999|pages=110–113|issn=1938-2650|doi=10.1159/000330961|pmid=10097694|s2cid=3360423}}
Diagnosis
MGH shows certain cytomorphologic features from pap smears, such as bi- or tridimensional cellular clusters consisting of glandular cells with vacuolated cytoplasm together with reserve cells with scant cytoplasm.{{cite journal|last1=Valente|first1=Philip T.|last2=Schantz|first2=H. Daniel|last3=Schultz|first3=Monica|title=Cytologic atypia associated with microglandular hyperplasia|journal=Diagnostic Cytopathology|volume=10|issue=4|year=1994|pages=326–331|issn=8755-1039|doi=10.1002/dc.2840100407|pmid=7924805|s2cid=39895781}} These features however are not characteristic exclusively to MGH, often being present in adenocarcinoma-affected tissue as well, and these tissues can be found merged with MGH areas. This results in difficulty distinguishing between endocervical lesions, and as such should not be used for diagnostic purposes.{{cite journal| author=Silverberg SG| title=Problems in the differential diagnosis of endometrial hyperplasia and carcinoma. | journal=Mod. Pathol. | year= 2000 | volume= 13 | issue= 3 | pages= 309–27 | pmid=10757341 | doi=10.1038/modpathol.3880053 | doi-access=free }}{{cite journal|vauthors=Cameron RI, Maxwell P, Jenkins D, McCluggage WG | title=Immunohistochemical staining with MIB1, bcl2 and p16 assists in the distinction of cervical glandular intraepithelial neoplasia from tubo-endometrial metaplasia, endometriosis and microglandular hyperplasia. | journal=Histopathology | year= 2002 | volume= 41 | issue= 4 | pages= 313–21 | pmid=12383213 | doi= 10.1046/j.1365-2559.2002.01465.x}}{{cite journal|vauthors=Young RH, Scully RE | title=Uterine carcinomas simulating microglandular hyperplasia. A report of six cases. | journal=Am. J. Surg. Pathol. | year= 1992 | volume= 16 | issue= 11 | pages= 1092–7 | pmid=1471729 | doi= 10.1097/00000478-199211000-00008| s2cid=21549513 }}{{cite journal|last1=Yahr|first1=Laura J.|last2=Lee|first2=Kenneth R.|title=Cytologic findings in microglandular hyperplasia of the cervix|journal=Diagnostic Cytopathology|volume=7|issue=3|year=1991|pages=248–251|issn=8755-1039|doi=10.1002/dc.2840070308|pmid=1879260|s2cid=9072204}}
The presence of subnuclear vacuoles is often observed in MGH, whereas squamous metaplasia, stromal foam cells, mitotic activity, vimentin and MIB‐1 expression are rather more often observed in adenocarcinoma.{{cite journal|last1=Qiu|first1=Wansong|last2=Mittal|first2=Khush|title=Comparison of Morphologic and Immunohistochemical Features of Cervical Microglandular Hyperplasia with Low-grade Mucinous Adenocarcinoma of the Endometrium|journal=International Journal of Gynecological Pathology|volume=22|issue=3|year=2003|pages=261–265|issn=0277-1691|doi=10.1097/01.PGP.0000071043.12278.8D|pmid=12819393|s2cid=26010265}}{{cite journal|vauthors=Florescu M, Simionescu C, Georgescu CV, Marinescu M | title=Histopathologic aspects in microglandular hyperplasia of endocervix. | journal=Rom J Morphol Embryol | year= 1999 | volume= 45 | pages= 181–4 | pmid=15847393 }}
Incidence
MGH is often observed idiopathically in pregnant women, as well as women exposed to diethylstilbestrol both as a contraceptive or in-utero, however this association is not statistically significant.{{cite journal|vauthors=Wilkinson E, Dufour DR | title=Pathogenesis of microglandular hyperplasia of the cervix uteri. | journal=Obstet Gynecol | year= 1976 | volume= 47 | issue= 2 | pages= 189–95 | pmid=1250541 }}{{cite journal|vauthors=Greeley C, Schroeder S, Silverberg SG | title=Microglandular hyperplasia of the cervix: a true "pill" lesion? | journal=Int. J. Gynecol. Pathol. | year= 1995 | volume= 14 | issue= 1 | pages= 50–4 | pmid=7883426 | doi= 10.1097/00004347-199501000-00009}} It has been suggested that HPV infection is an initial step towards the carcinogenesis in these lesions.{{cite journal|vauthors=Tase T, Okagaki T, Clark BA, Twiggs LB, Ostrow RS, Faras AJ | title=Human papillomavirus DNA in glandular dysplasia and microglandular hyperplasia: presumed precursors of adenocarcinoma of the uterine cervix. | journal=Obstet Gynecol | year= 1989 | volume= 73 | issue= 6 | pages= 1005–8 | pmid=2542853 | doi= 10.1097/00006250-198906000-00020| s2cid=21791825 }}
See also
References
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Further reading
- {{cite journal |vauthors=Speers WC, Picaso LG, Silverberg SG |title=Immunohistochemical localization of carcinoembryonic antigen in microglandular hyperplasia and adenocarcinoma of the endocervix |journal=American Journal of Clinical Pathology |year=1983 |volume=79 |issue=1 |pages=105–7 |pmid=6336881 |doi=10.1093/ajcp/79.1.105 }}
- {{cite journal|vauthors=Zaloudek C, Hayashi GM, Ryan IP, Powell CB, Miller TR | title=Microglandular adenocarcinoma of the endometrium: a form of mucinous adenocarcinoma that may be confused with microglandular hyperplasia of the cervix. | journal=Int. J. Gynecol. Pathol. | year= 1997 | volume= 16 | issue= 1 | pages= 52–9 | pmid=8986533 | doi= 10.1097/00004347-199701000-00009| s2cid=32772129 }}
- {{cite journal|vauthors=Jones MW, Silverberg SG | title=Cervical adenocarcinoma in young women: possible relationship to microglandular hyperplasia and use of oral contraceptives. | journal=Obstet. Gynecol. | year= 1989 | volume= 73 | issue= 6 | pages= 984–9 | pmid=2726119 | doi= 10.1097/00006250-198906000-00015}}
- {{cite journal|vauthors=Robboy SJ, Welch WR | title=Microglandular hyperplasia in vaginal adenosis associated with oral contraceptives and prenatal diethylstilbestrol exposure. | journal=Obstet Gynecol | year= 1977 | volume= 49 | issue= 4 | pages= 430–4 | pmid=857207 }}
- {{cite journal |vauthors=Nichols TM, Fidler HK |title=Microglandular hyperplasia in cervical cone biopsies taken for suspicious and positive cytology |journal=American Journal of Clinical Pathology |year=1971 |volume=56 |issue=4 |pages=424–9 |pmid=5113397 |doi=10.1093/ajcp/56.4.424 }}
- {{cite journal|vauthors=Young RH, Scully RE | title=Atypical forms of microglandular hyperplasia of the cervix simulating carcinoma. A report of five cases and review of the literature |journal=Am. J. Surg. Pathol. | year= 1989 | volume= 13 | issue= 1 | pages= 50–6 | pmid=2535775 | doi= 10.1097/00000478-198901000-00007| s2cid=8577678 }}
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