Minimal-deviation adenocarcinoma (adenoma malignum) of the uterine cervix; four case reports

Four cases of minimal-deviation adenocarcinoma (adenoma malignum) of the uterine cervix are analysed in this clinicopathological study. Four patients, one Ib, two IIb and one IIIb stage, showed poor prognosis, which included three patients who died within 36 months, because of diagnostic delays of 5 years, 6 months and 1 year due to cytohistologically benign appearances. Cytologically, the nuclei were somewhat more irregular in size and shape than those of normal columnar epitherial cells. Slightly multilayered cell clusters were arranged as honeycombs, palisades or sheets with glandular openings. The characteristic histological features were the presence of sharp points projecting from the glands and marked variation in the size and shape of the glands. Ultrastructurally, intestinal metaplastic cells containing both microvilli with core filaments and rootlets, and secretary granules in the same cell were present in the specimens of two evaluable patients. These features indicate a disorder of differentiation. In order to diagnose this tumor accurately, comprehensive analysis should be required concerning the clinical features, cytohistological findings and ultrastructural findings.