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MR findings of pseudoneoplastic lesions in the uterine cervix mimicking adenoma malignum

¹ Department of Radiology, Seirei Numazu Hospital, 902-6 Shichitanda Matsushita Hon-aza, Numazu, Shizuoka, 410-8555 and ² Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan

View larger version (58K): [in this window] [in a new window]   Figure 1. Endocervical glandular hyperplasia seen in a 54-year-old woman with lower abdominal pain, histopathologically proven by conization. (a) Fat-suppressed T1 weighted spin echo axial image depicts multiple small cysts in the enlarged uterine cervix extending into deep cervical stroma. (b) A photomicrograph shows endocervical glandular hyperplasia without cellular atypia. (original magnification x10; haematoxylin & eosin stain)

View larger version (70K): [in this window] [in a new window]   Figure 2. A 76-year-old woman with malignant ovarian tumour. Deep nabothian cysts were found incidentally in the hysterectomy specimen. (a) T2 weighted spin echo sagittal image shows the multilocular cystic lesions in the enlarged uterine cervix. (b) Fat-suppressed gadolinium-enhanced T1 weighted spin echo sagittal image depicts multiple cystic lesions within the cervical stroma. The cyst walls are somewhat thickened and slightly enhanced. (c) A photomicrograph shows multiple mucin-containing cysts composed of a single layer of columnar cells (original magnification x10; haematoxylin & eosin stain).

View larger version (94K): [in this window] [in a new window]   Figure 3. Tunnel cluster seen in a 57-year-old woman complaining of a large amount of watery discharge (histopathologically proven by conization). (a) T2 weighted spin echo axial image shows multilocular cystic lesions in the uterine cervix. (b) A photomicrograph shows lobulated aggregates of dilated endocervical glands filled with mucin. Cellular atypia is not observed. The destructive areas on the cyst walls are partially seen where mucinous fluid leakage occurs (original magnification x10; haematoxylin & eosin stain).

View larger version (74K): [in this window] [in a new window]   Figure 4. Adenoma malignum seen in a 49-year-old woman with a large amount of watery discharge (histopathologically proven from a hysterectomy specimen; shown as a reference case). (a) Fat-suppressed T2 weighted spin echo axial image depicts multilocular cystic lesions extending into deep cervical stroma with perifocal oedema. (b) Fat-suppressed gadolinium-enhanced T1 weighted sagittal image depicts multilocular cystic mass. The cyst walls are slightly thickened, and nodularly enhanced areas are shown among the cysts. (c) A photomicrograph shows multiple cystic lesions composed of a single layer of columnar cells that resemble normal endocervical glands. However, most glands have cellular atypia and structural dysplasia with multiple lobulations demonstrating a "hair-pin" shape. In another specimen (not shown), mucinous fluid leakage into the cervical stroma is also seen. Taking all of the above findings into consideration, adenoma malignum is thus considered to be the most likely histopathological diagnosis (original magnification x10; haematoxylin & eosin stain).