Published online May 20, 2022. doi: 10.5317/wjog.v11.i2.8
Peer-review started: February 13, 2021
First decision: March 31, 2021
Revised: May 12, 2021
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: May 20, 2022
Processing time: 458 Days and 17.4 Hours
Microglandular hyperplasia (MGH) is a proliferation of endocervical glands, related to estrogen stimulation, mainly occurring in the reproductive age group. The differential diagnosis includes endometrial adenocarcinoma with MGH-like pattern (MGA), a distinction that may be particularly problematic in curettage specimen.
A 57-year-old, postmenopausal woman was admitted in our hospital for surgical treatment. She had been diagnosed with a uterine leiomyoma, after complaints of irregular vaginal bleeding. She underwent dilatation and curettage (D&C) and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy. D&C were compatible with MGA. Histologically, a proliferation of small glands, without intervening stroma, with mucin production, accumulation of neutrophils in the gland lumen and stroma, mild nuclear atypia and rare mitoses, were seen. In the hysterectomy specimen, the endometrium was thickened, but without apparent tumor formation. On microscopic examination, a residual similar adenocarcinoma was seen in the isthmus and more conventional-of endometrioid and mucinous type, in the rest of the endometrium.
MGH-like proliferation with mild cytologic atypia, detected in the endometrial curettage specimen of a postmenopausal woman, should alert pathologists for MGA of the endometrium. VIM, p16, PAX-2, CD10 and CD34 may help in the differential diagnosis.
Core Tip: When microglandular hyperplasia (MGH)-like proliferation is detected in the endometrial curettage of a postmenopausal woman, the pathologists must be vigilant for endometrial MGH-like endometrial adenocarcinoma type of carcinoma, as it may be misdiagnosed. The examination of scant biopsy specimens remains a challenge. Its recognition can avoid underdiagnosis and mistreatment of the patient.