Trihia HJ, Souka E, Galanopoulos G, Pavlakis K, Karelis L, Fotiou A, Provatas I. Microglandular hyperplasia-like mucinous adenocarcinoma of the endometrium: A rare case report. World J Obstet Gynecol 2022; 11(2): 8-16 [DOI: 10.5317/wjog.v11.i2.8]
Corresponding Author of This Article
Helen J Trihia, MD, MSc, PhD, Chief Doctor, Department of Pathology, ‘Metaxas’ Memorial Cancer Hospital, 51, Mpotassi str, Piraeus 18537, Greece. eltrix@otenet.gr
Research Domain of This Article
Pathology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Obstet Gynecol. May 20, 2022; 11(2): 8-16 Published online May 20, 2022. doi: 10.5317/wjog.v11.i2.8
Microglandular hyperplasia-like mucinous adenocarcinoma of the endometrium: A rare case report
Helen J Trihia, Efthymia Souka, George Galanopoulos, Kitty Pavlakis, Loukas Karelis, Alexandros Fotiou, Ioannis Provatas
Helen J Trihia, Efthymia Souka, George Galanopoulos, Loukas Karelis, Department of Pathology, ‘Metaxas’ Memorial Cancer Hospital, Piraeus 18537, Greece
Kitty Pavlakis, Department of Pathology, National & Kapodistrian University of Athens, Athens 11527, Greece
Kitty Pavlakis, Department of Pathology, ‘IASO’ General Maternity & Gynecological Clinic, Maroussi, Athens 15123, Greece
Alexandros Fotiou, Department of Gynaecologic Oncology, ‘Metaxas’ Memorial Cancer Hospital, Piraeus 18537, Greece
Ioannis Provatas, Department of Pathology, Evangelismos District General Hospital, Athens 10676, Greece
Author contributions: Trihia HJ diagnosed the case and authored the paper; Pavlakis K confirmed diagnosis (second opinion); Fotiou A supported surgical management; Galanopoulos G took macroscopic photos; Rest co-authors helped in the review of the manuscript.
Informed consent statement: There is oral and written informed consent from the patient, if requested.
Conflict-of-interest statement: There is no conflict of interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Helen J Trihia, MD, MSc, PhD, Chief Doctor, Department of Pathology, ‘Metaxas’ Memorial Cancer Hospital, 51, Mpotassi str, Piraeus 18537, Greece. eltrix@otenet.gr
Received: February 13, 2021 Peer-review started: February 13, 2021 First decision: March 31, 2021 Revised: May 12, 2021 Accepted: March 27, 2022 Article in press: March 27, 2022 Published online: May 20, 2022
Abstract
BACKGROUND
Microglandular hyperplasia (MGH) is a proliferation of endocervical glands, related to estrogen stimulation, mainly occurring in the reproductive age group. The differential diagnosis includes endometrial adenocarcinoma with MGH-like pattern (MGA), a distinction that may be particularly problematic in curettage specimen.
CASE SUMMARY
A 57-year-old, postmenopausal woman was admitted in our hospital for surgical treatment. She had been diagnosed with a uterine leiomyoma, after complaints of irregular vaginal bleeding. She underwent dilatation and curettage (D&C) and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy. D&C were compatible with MGA. Histologically, a proliferation of small glands, without intervening stroma, with mucin production, accumulation of neutrophils in the gland lumen and stroma, mild nuclear atypia and rare mitoses, were seen. In the hysterectomy specimen, the endometrium was thickened, but without apparent tumor formation. On microscopic examination, a residual similar adenocarcinoma was seen in the isthmus and more conventional-of endometrioid and mucinous type, in the rest of the endometrium.
CONCLUSION
MGH-like proliferation with mild cytologic atypia, detected in the endometrial curettage specimen of a postmenopausal woman, should alert pathologists for MGA of the endometrium. VIM, p16, PAX-2, CD10 and CD34 may help in the differential diagnosis.
Core Tip: When microglandular hyperplasia (MGH)-like proliferation is detected in the endometrial curettage of a postmenopausal woman, the pathologists must be vigilant for endometrial MGH-like endometrial adenocarcinoma type of carcinoma, as it may be misdiagnosed. The examination of scant biopsy specimens remains a challenge. Its recognition can avoid underdiagnosis and mistreatment of the patient.
