Cytologic findings in minimal deviation adenocarcinoma (adenoma malignum) of the cervix. A report of seven cases.

Minimal deviation adenocarcinoma (MDA) is a rare extremely well-differentiated form of invasive cervical adenocarcinoma. Because of its rarity and perhaps because cytologic changes are subtle and may be missed, there are only a few reports that illustrate the cytologic features of this neoplasm. To better understand the presentation of MDA in cervical smears and the role of cytology in diagnosing this lesion, the authors reviewed the clinical, histologic, and cytologic finding in seven patients. In two cases, MDA was an incidental finding in the a hysterectomy specimen. Three patients had a vaginal discharge and one patient had a "beefy red" cervix noted on pelvic examination. Although all 7 patients had cervical smears taken within 1 to 17 months before biopsy, in only one of the patients did the cervical smear lead to the diagnosis. On review, all smears from four patients were considered normal. In six smears from the remaining three patients, there were abnormal glandular cells that ranged from atypical to suspicious for well-differentiated adenocarcinoma in retrospect. All of these patients had minor foci of less well-differentiated carcinoma in their tumors. In 11 smears from 5 patients, including the smears with diagnostic cells, there were cells that we believe were from the MDA, but may not be diagnosable as malignant even in retrospect. These cells have not been described before in association with MDA. They are enlarged glandular cells, usually in honeycombed sheets with abundant cytoplasm. Nuclei are uniform with fine chromatin and small nucleoli. They lack pleomorphism and mitoses are only occasionally seen. We believe that in the absence of focal areas of more poorly differentiated adenocarcinoma, these cells are not sufficiently distinct from reactive endocervical cells to allow for a definitive diagnosis. However, awareness of their appearance, especially if seen in large sheets may allow the smear to be diagnosed as abnormal and lead to the correct diagnosis on a biopsy.