A 39-year-old woman presents with profuse watery vaginal discharge. Biopsy of the cervix shows extremely well-differentiated glands lined by bland mucin-filled epithelium that infiltrate deeply into the stroma yet appear deceptively benign. She gives a history of pigmented macules on the lips and hamartomatous polyps. The most likely diagnosis is:

• A Tunnel clusters
• B Microglandular hyperplasia
• C Minimal deviation adenocarcinoma (adenoma malignum) ✓
• D Endometriosis of the cervix

Explanation

Minimal deviation adenocarcinoma, historically called adenoma malignum, is a highly differentiated variant of gastric-type endocervical adenocarcinoma. Its glands mimic benign Nabothian cysts despite deep stromal infiltration, and it is classically associated with Peutz-Jeghers syndrome, which the mucocutaneous pigmentation and hamartomatous polyps indicate. Microglandular hyperplasia and tunnel clusters are benign and superficially located, killing both distractors.

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.