Glandular Adenomatous Hyperplasia of the Endocervix

New glands form and the glandular epithelial cells become pseudostratified (Fig. 62), containing elongated hyperchromatic nuclei in a less well-differentiated cytoplasm. The glands may ramify (Fig. 59) or become crowded (Fig. 60), occasionally resulting in a diffuse laminar glandular pattern (Jones et al. 1991; Nucci 2002). The production of mucin is reduced or absent and occurs irregularly from one gland to another (Fig. 61) or within the same gland (Fig. 62). Cells with mucin and those without may lie together. In addition, the chemical composition of the mucus is often changed (Gaton et al. 1982).

The reserve cells underneath the glandular and superficial epithelium may undergo hyperplasia to form several layers. That hyperplasia is stimulated by the gestagens. Such hyperplastic reserve cells may appear quite immature and contain depolarized hyperchromatic nuclei (Gall et al. 1969).

■ Differential Diagnosis. These adenomatous proliferations have to be distinguished from a well-differentiated adenocarcinoma of the endocervix. The invading carcinomatous glands induce, in most instances, a stromal reaction as they grow into the cervical wall. A large biopsy of the cervical wall may be required to make the distinction with H & E sections. If only a small portion of tissue is available, the immunohistochemical reaction for CEA is of great help - an adenomatous hyperplasia is negative for CEA, whereas an invasive adenocarcinoma reacts positively in most cases. An ACIS can be distinguished from adenomatous hyperplasia by its cytological atypias, cellular stratification, densely arranged hyperchromatic nuclei, and by its positive immunostaining reaction for CEA (Fig. 140a). p16INK4a is diffusely positive in adenocarcinoma and ACIS, whereas it is negative or focally positive in adenomatous hyperplasia.

It is well known that milder degrees of epithelial atypia may develop in some or parts of glands in cases of ACIS and invasive adenocarcinoma of the cervix. Similar epithelial atypia may also occur alone. For these changes the term cervical glandular atypia has been proposed; they probably represent a continuum from low-grade atypia to ACIS (Wells and Brown 1986). In the current WHO classification these changes are termed glandular dysplasia (Zaino 2002; Tavassoli and Devilee 2003).

Pas Endocervix
Fig. 60. Glandular (adenomatous) hyperplasia of endocervix with crowding of glands. H&E
Pas Positive Mucous Cells Endocervix
Fig. 61. Glandular (adenomatous) hyperplasia of endocervix, variable content of mucin from one gland to another. PAS reaction

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