Diagnostic dilemma in cervical endocervicosis

Abstract

Müllerianosis is an embryonic Müllerian disease, resulting in the formation of the benign diseases adenomyosis, endometriosis, endosalpingiosis, and endocervicosis. Endocervicosis primarily affects the bladder, and rarely the cervix. Cervical endocervicosis, which is also a pseudoneoplastic glandular lesion, could be misinterpreted as a premalignant or even a malignant lesion. Because the treatment of these diseases is very different, early clinical diagnosis is important. Unfortunately, however, this lesion is difficult to diagnose preoperatively using clinical and radiological information, and pathological confirmation is needed. Herein, we report a rare case of cervical endocervicosis that was difficult to diagnosis preoperatively.

Keywords: Adenoma malignum; Differential diagnosis; Endocervicosis; Müllerianosis; Pseudoneoplastic glandular lesion.

Fig. 1. (A) T1-weighted axial image of the pelvis showing a multiloculated cystic lesion not invading the cervical stroma with high-signal intensity. (B) T2-weighted axial image of the pelvis showing a multiloculated cystic lesion not invading the cervical stroma with high-signal intensity.

Fig. 2. (A) The cervix shows several deep-seated cystic spaces. The cysts are filled with mucin (H&E, ×20). (B) The cystic wall is lined by single layer of mucinous columnar epithelium (H&E, ×800). (C) The lining cells of the cyst show diffuse cytokeratin 7 expression (immunohistochemistry for cytokeratin 7, ×20). (D) The cystic wall shows a low Ki 67 labeling index (immunohistochemistry for Ki 67, ×400).