Limited frequency of malignant change in lobular endocervical glandular hyperplasia

Abstract

IntroductionAlthough lobular endocervical glandular hyperplasia is a benign disorder of the uterine cervix, its potential as a precursor of minimal deviation adenocarcinoma has been reported. However, the natural history of the disease and the frequency of malignant change are not fully understood. We evaluated the frequency of malignant change of clinical lobular endocervical glandular hyperplasia and explored useful parameters indicating malignant change.MethodsThe clinical courses of 175 patients with cervical multi-cystic lesions who visited Shinshu University Hospital between June 1995 and June 2019 were retrospectively analyzed. We examined the results of follow-up and outcomes of the patients diagnosed with lobular endocervical glandular hyperplasia and investigated the frequency of malignant transformation.ResultsOf the 175 patients, 15, 84, and 76 were clinically diagnosed with suspected malignancy, suspected lobular endocervical glandular hyperplasia, and suspected nabothian cyst, respectively. Of these patients, 69 patients with suspected lobular endocervical glandular hyperplasia were followed, and 12 underwent hysterectomy after a mean follow-up of 57.1 (range: 3–154) months due to lesion enlargement (increase in tumor diameter of >20%) and/or worsening cytology. Of these 12 patients, two had lobular endocervical glandular hyperplasia with atypia and one had minimal deviation adenocarcinoma. Of 69 patients, the rate of malignant change was 1.4% (1/69). The growth rates of the lesions for these three patients during follow-up were significantly higher than those of nine patients who underwent surgery with lobular endocervical glandular hyperplasia without atypia and 48 follow-up cases of suspected lobular endocervical glandular hyperplasia. The cut-off value of the growth rate suggesting malignant transformation was 38.1% (84.6% sensitivity and 100% specificity). Tumor size and cytology did not change in the remaining 57 cases continuing follow-up.ConclusionAn increase in tumor size and worsening cytology are important parameters for detecting malignant transformation of lobular endocervical glandular hyperplasia during follow-up. However, the frequency of malignant change of this disease may be limited. These results suggest that conservative management may be an option for clinical lobular endocervical glandular hyperplasia.

Biology and management of lobular endocervical glandular hyperplasia

“…Especially, AGC‐NOS suggested benign (nonatypical) LEGH, whereas AGC‐FN suggested atypical LEGH or MDA/GAS 44,45 . Collectively, cervical cytology is useful to distinguish benign LEGH and MDA/GAS/atypical LEGH 14,26,42 . (Figure 6a, b).…”

Human papillomavirus‐independent cervical cancer and its precursor lesions

“…Sectioning of the specimen at multiple levels is necessary for a thorough histological assessment to rule out a coexistent adenocarcinoma. In a longitudinal study by Kobara et al., 18 women with suspected LEGH who did not undergo hysterectomy had periodic surveillance using MRI and cervical smears. An increasing lesion size of >38% on MRI assessment and worsening cervical cytology was closely associated with onset of malignant transformation in cases of LEGH 18 .…”

“…LEGH by itself is considered a benign lesion, but it can coexist with atypical areas, GAIS or even adenocarcinoma. LEGH may progress to GAC in 1.5% of cases, although in many instances adenocarcinoma arises de novo or from GAIS 18 . Comparative genomic hybridisation studies have shown recurrent chromosomal imbalances, in the form of gains of chromosome 3q and loss of 1p in around 20% of LEGH, with these alterations also being present in adenoma malignum and other cervical mucinous adenocarcinomas 19 …”

“…Currently, there are no defined or separate guidelines for the management of glandular cervical tumours taking HPV association into account. Although LEGH is considered a benign lesion, malignant transformation can occur in 1.4% of cases 18 . If diagnosed on a loop excision or cone biopsy of cervix, there is a risk of missing coexistent atypical LEGH, GAIS or GAC higher in the endocervical canal.…”

“…In a longitudinal study by Kobara et al., 18 women with suspected LEGH who did not undergo hysterectomy had periodic surveillance using MRI and cervical smears. An increasing lesion size of >38% on MRI assessment and worsening cervical cytology was closely associated with onset of malignant transformation in cases of LEGH 18 . Patients with LEGH or in situ lesions who are keen to preserve fertility and undergo loop excision, cone biopsy or simple trachelectomy need careful surveillance with clinical review, regular cervical smears and MRI examinations.…”