Endocervicosis involving the uterine cervix: a report of four cases of a benign process that may be confused with deeply invasive endocervical adenocarcinoma.

Four cases of endocervicosis that involved the outer cervical wall and paracervical connective tissue are reported; in one case there was also transmural involvement of the urinary bladder. A diagnosis of cervical adenocarcinoma was an initial concern of the referring pathologist in three cases. The patients were from 29 to 45 years of age; there was a history of cesarean section in two cases. Two patients presented with pelvic pain, one with dysmenorrhea, and one with symptoms related to an ovarian tumor. In three cases, a gross abnormality of the outer aspect of the cervix was noted at the time of hysterectomy and in the fourth at the time of macroscopic pathologic examination. The anterior wall of the cervix in each case was involved by a firm rubbery mass, 1 to 2.5 cm in maximal dimension, with cysts seen on sectioning in two. Microscopic examination disclosed a dominant population of glands of variable size and shape, including cystically dilated glands, lined by mucinous endocervical-type epithelium that ranged from columnar to flattened. All the glands had lining cells with bland cytologic features with absent to rare mitotic figures. A periglandular stromal reaction, present in two cases, was related to mucin extravasation. A cuff of endometriotic stroma was present around rare glands in one case. The appearance of the lesion was similar to that of endocervicosis of the urinary bladder, and as in that site, raised concern for adenocarcinoma, specifically for the minimal deviation (adenoma malignum) type of cervical adenocarcinoma. Awareness of the distinctive features of endocervicosis in this site, including its dominant location in the outer portion of the cervix and paracervical connective tissue and the typical presence of an uninvolved zone of cervical wall between the endocervicosis and the eutopic endocervical glands, facilitate the correct diagnosis.