Under estrogenic stimulation, the epithelial cells of the endocervical glands differentiate and produce mucin, which may become excessive with long-standing unopposed estrogen. Consequently, the glands become cystically dilated with inspissated mucin (Figs. 52-54). Thereby they become closely clustered, and the glandular region enlarges by extending down into the cervical wall. Reserve cells or areas of preceding reserve cell hyperplasia may differentiate and undergo squamous cell metaplasia (see p. 24).
Subinvolution of previously cystic hyperplastic glands may result in the formation of tunnel clusters (Fig. 52), consisting of multifocal areas of closely packed, dilated endo-cervical glands with inspissated mucus. The glandular epithelium is mostly flat, non-atypical. Occasional foci may contain noncystic, closely packed glands lined by slightly irregular epithelium and may falsely be interpreted as adenocarcinoma with minimal deviation. Distinction from carcinoma is possible by their lack of invasion and the negative reaction for CEA (Segal and Hart 1990; Gilks at al. 1989).
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