Definition/General
Introduction:
Cervical microglandular hyperplasia (MGH) is a benign proliferative lesion of endocervical glands characterized by small, closely packed glands with minimal intervening stroma
It is primarily caused by progestin stimulation.
Origin:
Results from progestin stimulation of endocervical glandular epithelium, most commonly from oral contraceptives, pregnancy, or hormone replacement therapy
Represents hormonally-induced hyperplastic response.
Classification:
WHO Classification categorizes as benign hormonal hyperplasia
Considered a physiological response to progestin stimulation
May be focal or diffuse.
Epidemiology:
Common in reproductive-age women using oral contraceptives
Also seen in pregnancy and with exogenous hormone use
Peak incidence 20-40 years.
Clinical Features
Presentation:
Often asymptomatic and incidental finding
May present as abnormal cervical appearance on examination
Can cause abnormal vaginal discharge.
Symptoms:
Usually asymptomatic
May cause increased vaginal discharge
Abnormal cervical appearance on speculum examination
Post-coital spotting occasionally.
Risk Factors:
Oral contraceptive use (most common)
Pregnancy
Progestin therapy
Hormone replacement therapy
Injectable contraceptives.
Screening:
Incidental finding on routine examination
May be detected on Pap smear
Colposcopy may show irregular cervical surface.
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Gross Description
Appearance:
Polypoid or papillary growth on cervical surface
Pink to red coloration
Soft, friable consistency
May have granular or "berry-like" appearance.
Characteristics:
Variable size (few mm to 2-3 cm)
Soft, spongy consistency
Pink to red color
Granular surface texture
May be polypoid.
Size Location:
Usually arises from endocervical canal
May protrude through external os
Can involve transformation zone
Single or multiple lesions.
Multifocality:
May be multifocal
Can coexist with other hormonal changes
Often associated with decidual changes in pregnancy.
Microscopic Description
Histological Features:
Closely packed small glands with minimal intervening stroma
Glands lined by single layer of cuboidal to low columnar epithelium
Abundant acute and chronic inflammatory cells.
Cellular Characteristics:
Glandular epithelium: cuboidal to low columnar cells
Minimal nuclear atypia
Abundant neutrophils within glands and stroma
Eosinophils may be present.
Architectural Patterns:
Back-to-back small glands with minimal stroma
Cystic dilatation of some glands
Surface may be ulcerated
Reserve cell hyperplasia may be present.
Grading Criteria:
Benign lesion (no grading system)
May show reactive atypia due to inflammation
Absence of significant cytologic atypia or mitotic activity.
Immunohistochemistry
Positive Markers:
CK7 positive in glandular epithelium
CEA positive
Progesterone receptor (PR) positive
Estrogen receptor (ER) variable.
Negative Markers:
p16 typically negative
High-risk HPV negative
CK20 negative
TTF-1 negative
Neuroendocrine markers negative.
Diagnostic Utility:
Usually morphological diagnosis
IHC rarely needed
CEA and CK7 confirm glandular nature
Hormone receptors support hormonal etiology.
Molecular Subtypes:
No specific molecular subtypes
Represents physiological response to hormonal stimulation.
Molecular/Genetic
Genetic Mutations:
No specific genetic alterations
Represents physiological hyperplastic response to hormonal stimulation
Normal chromosomal complement.
Molecular Markers:
Hormone receptors expressed
Ki-67 proliferation index may be elevated
Normal p53 expression
No significant genomic instability.
Prognostic Significance:
Excellent prognosis as benign condition
Complete regression expected after withdrawal of hormonal stimulus
No malignant potential.
Therapeutic Targets:
Discontinuation of progestin stimulus if possible
Conservative management
Surgical excision if symptomatic or diagnostic uncertainty.
Differential Diagnosis
Similar Entities:
Endocervical adenocarcinoma
Clear cell adenocarcinoma
Tunnel clusters
Minimal deviation adenocarcinoma
Endometriosis.
Distinguishing Features:
MGH: small regular glands, inflammation, hormone use history
Adenocarcinoma: irregular glands, cytologic atypia, invasion.
Diagnostic Challenges:
Distinction from well-differentiated adenocarcinoma
Small biopsy specimens may not show full architectural pattern
Clinical correlation essential.
Rare Variants:
Atypical microglandular hyperplasia
MGH with squamous metaplasia
MGH with extensive inflammation.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Prognostic Factors
Prognostic factors: [list factors]
Final Diagnosis
Final diagnosis: [complete diagnosis]