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Hormone Receptors in Microglandular Hyperplasia of the Uterine Cervix

Zamecnik, Michal M.D.

International Journal of Gynecological Pathology: October 2002 - Volume 21 - Issue 4 - p 424-425

Sikls's Department of Pathology,

Faculty Hospital, Charles University,

Pilsen, Czech Republic

To the Editor:

Microglandular hyperplasia (MGH) of the cervix can mimic cervical and endometrial adenocarcinomas that have a pattern resembling that of MGH, especially in a curettage or biopsy specimen (1). Although pure MGH-like uterine carcinomas are rare (2–5), a focal microglandular pattern in endometrial endometrioid adenocarcinomas is quite frequent (12% in the study by Jacques et al.) (6). Inspired by the recent use of hormone receptor immunostains in the differential diagnosis of uterine carcinomas by McCluggage et al. (7), I have wondered whether such immunostains could help in the differential diagnosis between MGH and microglandular endometrial and endocervical adenocarcinomas. Because I did not find in the Medline database any data on hormone receptor immunohistochemistry in MGH, I have performed these stains in eight cases of cervical MGH. The patients had an average age of 40.5 (range 25–59) years. All patients but one were premenopausal. Clinical diagnoses were CIN with cervical polyp in three cases, cervical polyp in three cases, and CIN in two cases. In all cases, a simple excision of the lesion was performed. All of the lesions showed the histologic features of MGH (1), which was synchronous with high-grade CIN in five. The epithelium of MGH in all but one case was completely negative for progesterone receptor (PR) (1A6, Immunotech, Marseilles, France) (Fig. 1). The exception was a case with slight and equivocal positivity in 30% of the cells. Estrogen receptor (ER) (1D5, Immunotech) was strongly positive in 80–100% of epithelial cells in all of the lesions (Fig. 2). The stromal cells were always strongly positive for PR and variably positive for ER. Thus, MGH is a typically ER+/PR− lesion. In contrast, endometrial adenocarcinomas (especially the well-differentiated ones that often contain MGH-like foci) express PR in a majority of cases (8–10). Cervical adenocarcinomas, which can also mimic MGH, are usually negative or only slightly positive for ER (7) in contrast with the consistent ER positivity of MGH.

FIG. 1.

FIG. 1.

FIG. 2.

FIG. 2.

Michal Zamecnik, M.D.

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