Cystic endocervical tunnel clusters. A clinicopathologic study of 29 cases of so-called adenomatous hyperplasia

The clinical and histologic features of cystic endocervical tunnel clusters (CETC) are not well known. Unwary pathologists have sometimes mistaken CETC for endocervical adenocarcinoma or interpreted them as "adenomatous hyperplasia." In this study, CETC were identified in 19 (5.9%) of 322 consecutive hysterectomy specimens and three (9.7%) of 31 consecutive cervical conization specimens accessioned during a 1-year period. These 22 cases were analyzed along with seven consultation cases. The 29 patients' ages ranged from 33 to 72 years (mean, 55). All but one (96.6%) were multigravida. Almost 80% of the patients had had at least three previous pregnancies. The mean gravidity and age of the hysterectomy patients with CETC were significantly greater than those without them. CETC typically were discovered incidentally during routine examination of the cervix. The clusters ranged from 0.5 to 18.8 mm (mean, 2.4 mm) in greatest dimension; they were multifocal in 82.8% of cases. CETC consisted of orderly, lobular aggregates of closely packed, dilated tubular endocervical "glands" within the superficial endocervix. The deepest clusters extended to a depth of 9.0 mm. They were commonly associated with multiple Nabothian cysts, which occasionally also penetrated deeply. The lining epithelium was a single layer of flattened or cuboidal endocervical cells. Mitotic figures and significant cytologic atypia were absent. None of the cases had intracytoplasmic CEA immunoreactivity, but in 52% focal positive CEA staining was noted along the luminal border of the endocervical cells. CETC are believed to result from subinvolution of previous episodes of physiologic hyperplasia of the endocervical mucosa, usually due to prior pregnancies. They are unrelated to cervical neoplasms and must be distinguished from adenocarcinoma and other glandular lesions of the endocervix.