Adenoma malignum of the cervix: a reappraisal

We here report a case of adenoma malignum of the cervix in a 59 year old woman with a 6 month history of a clear watery vaginal discharge. The tumor was an incidental finding in a hysterectomy specimen. Histological examination revealed irregular neoplastic glands formed by mucinous columnar epithelial cells with minimal cytological atypia and a focal stromal reaction. The endothelium of several large veins within the cervical stroma was replaced by neoplastic cells. All seven preoperative Pap smears were normal. The ovaries were normal. The difficulties in making a histological diagnosis of adenoma malignum justifies its separation from the more common well differentiated cervical adenocarcinomas. Furthermore in view of the difference in prognosis, cytohistomorphology and the known association with ovarian tumors, we recommend that the term "adenoma malignum" be retained but restricted to the mucinous endocervical type of minimal deviation adenocarcinoma.