A 47-year-old woman presents with watery discharge and a bulky cervix. Biopsy shows extremely well differentiated glands lined by cytologically bland mucin-rich columnar cells infiltrating deeply into the cervical stroma. Immunohistochemistry is positive for HIF-1 beta (HNF-1beta) and serum CEA is elevated. The most likely diagnosis is:
- A Endometrioid adenocarcinoma of the cervix
- B Minimal deviation adenocarcinoma (gastric type, adenoma malignum) ✓
- C Clear cell carcinoma associated with in-utero diethylstilboestrol exposure
- D Metastatic gastric adenocarcinoma to the cervix
Correct answer: B. Minimal deviation adenocarcinoma (gastric type, adenoma malignum)
Explanation
Minimal deviation adenocarcinoma, also called adenoma malignum, is a gastric-type cervical adenocarcinoma with deceptively benign cytology yet deep stromal invasion, classically presenting with watery discharge and carrying a poor prognosis despite its bland appearance. It is associated with Peutz-Jeghers syndrome and shows gastric markers such as HIK1083 and HNF-1beta positivity. Clear cell carcinoma linked to DES exposure arises in younger women with distinct hobnail architecture, and metastatic gastric cancer lacks this primary pattern.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.