With increasing potency of the gestagen used, endocervical glandular proliferation is more likely to develop into microalveolar changes with disappearance of the intervening stroma (Figs. 63-65). The low cuboidal, undifferentiated, glandular epithelial cells can hardly be distinguished from the surrounding hyperplastic reserve cells. Occasionally a solid sheetlike proliferation of reserve cells, signet-ring cells or hobnail cells may be observed. These changes, too, may be misdiagnosed as invasive adenocarcinoma or clear cell carcinoma (Taylor et al. 1967; Candy and Abell 1968; Kyriakos et al. 1968; Talbert and Shery 1969; Helmerhorst et al. 1984; Wells and Brown 1986; Young and Scully 1989).
■ Differential Diagnosis. Several features may help to differentiate a microglandular hy-perplasia from an invasive carcinoma. The cells of microglandular hyperplasia show less nuclear atypia, they have a low proliferation index (MIB-1) and their cytoplasm contains mucin, not glycogen. In contrast to invasive adenocarcinoma, microglandular hyperplasia reacts negatively for CEA and for p16INK4a.
Glandular Papillary Ectropion (Fig. 66)
As a result of excessive proliferation and growth pressure, the endocervical mucosa frequently protrudes onto the ectocervical surface (Fig. 66). Under gestagenic stimulation, epidermization of such an ectropion is usually initiated by reserve cell hyperplasia ("descending repair," p. 24).
Polyps of the Ecto- and Endocervix (Figs. 67-69)
Focal proliferation of the endocervical mucosa leads to polyp formation. Depending upon their glands, they may be either cystic (Fig. 67), adenomatous, or microglandular; depending upon their stromal content, they may be either fibrous, angiomatous (Fig. 68), edematous (Fig. 67), or cellular (Fig. 68). Their surface may be papillary (Fig. 67) or smooth (Fig. 68). When these polyps protrude through the external os, the surface epithelium may be replaced by reserve cell hyperplasia (Fig. 68), which can differentiate to squamous metaplasia and finally to mature stratified squamous epithelium. When such polyps are completely overgrown by squamous epithelium, they are then classified as ectocervical polyps (Fig. 69).
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