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

Akiko Takatsu, Tanri Shiozawa, Tsutomu Miyamoto, Kazuko Kurosawa, Hiroyasu Kashima, Tomoko Yamada, Tsunehisa Kaku, Yoshiki Mikami, Takako Kiyokawa, Hitoshi Tsuda, Keiko Ishii, Kaori Togashi, Takashi Koyama, Yasunari Fujinaga, Masumi Kadoya, Akihiko Hashi, Nobuyuki Susumu, Ikuo Konishi

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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 MDAwere 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 structurewith inner solid components onMRI 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.

Original languageEnglish
Pages (from-to)1287-1296
Number of pages10
JournalInternational Journal of Gynecological Cancer
Volume21
Issue number7
DOIs
Publication statusPublished - Oct 1 2011

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Cervix Uteri
Multicenter Studies
Hyperplasia
Adenocarcinoma
Differential Diagnosis
Magnetic Resonance Imaging
Gastric Mucins
Papanicolaou Test
Conization
Recurrence
Mucinous Adenocarcinoma
Hysterectomy
Cysts

All Science Journal Classification (ASJC) codes

  • Oncology
  • Obstetrics and Gynaecology

Cite this

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. / Takatsu, Akiko; Shiozawa, Tanri; Miyamoto, Tsutomu; Kurosawa, Kazuko; Kashima, Hiroyasu; Yamada, Tomoko; Kaku, Tsunehisa; Mikami, Yoshiki; Kiyokawa, Takako; Tsuda, Hitoshi; Ishii, Keiko; Togashi, Kaori; Koyama, Takashi; Fujinaga, Yasunari; Kadoya, Masumi; Hashi, Akihiko; Susumu, Nobuyuki; Konishi, Ikuo.

In: International Journal of Gynecological Cancer, Vol. 21, No. 7, 01.10.2011, p. 1287-1296.

Research output: Contribution to journalArticle

Takatsu, A, Shiozawa, T, Miyamoto, T, Kurosawa, K, Kashima, H, Yamada, T, Kaku, T, Mikami, Y, Kiyokawa, T, Tsuda, H, Ishii, K, Togashi, K, Koyama, T, Fujinaga, Y, Kadoya, M, Hashi, A, Susumu, N & Konishi, I 2011, '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', International Journal of Gynecological Cancer, vol. 21, no. 7, pp. 1287-1296. https://doi.org/10.1097/IGC.0b013e31821f746c
Takatsu, Akiko ; Shiozawa, Tanri ; Miyamoto, Tsutomu ; Kurosawa, Kazuko ; Kashima, Hiroyasu ; Yamada, Tomoko ; Kaku, Tsunehisa ; Mikami, Yoshiki ; Kiyokawa, Takako ; Tsuda, Hitoshi ; Ishii, Keiko ; Togashi, Kaori ; Koyama, Takashi ; Fujinaga, Yasunari ; Kadoya, Masumi ; Hashi, Akihiko ; Susumu, Nobuyuki ; Konishi, Ikuo. / 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. In: International Journal of Gynecological Cancer. 2011 ; Vol. 21, No. 7. pp. 1287-1296.
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T2 - A multicenter study of clinicopathology and magnetic resonance imaging findings

AU - Takatsu, Akiko

AU - Shiozawa, Tanri

AU - Miyamoto, Tsutomu

AU - Kurosawa, Kazuko

AU - Kashima, Hiroyasu

AU - Yamada, Tomoko

AU - Kaku, Tsunehisa

AU - Mikami, Yoshiki

AU - Kiyokawa, Takako

AU - Tsuda, Hitoshi

AU - Ishii, Keiko

AU - Togashi, Kaori

AU - Koyama, Takashi

AU - Fujinaga, Yasunari

AU - Kadoya, Masumi

AU - Hashi, Akihiko

AU - Susumu, Nobuyuki

AU - Konishi, Ikuo

PY - 2011/10/1

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N2 - 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 MDAwere 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 structurewith inner solid components onMRI 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.

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