A 46-year-old woman with Peutz-Jeghers syndrome undergoes hysterectomy for a bulky cervix. Histology shows extremely well-differentiated glands lined by mildly atypical mucinous epithelium infiltrating deeply into the cervical stroma, with minimal desmoplastic reaction. Multiple Pap smears over preceding years were normal. The most likely diagnosis is:

• A Endometrioid adenocarcinoma of the cervix
• B Adenoma of Nabothian cysts with pseudoinfiltration
• C Minimal deviation adenocarcinoma (gastric type, adenoma malignum) ✓
• D Villoglandular papillary adenocarcinoma

Explanation

Minimal deviation adenocarcinoma, now classified as gastric type, is composed of deceptively benign-looking mucinous glands that invade deeply with little stromal response, so it evades routine cytology. It is classically linked to Peutz-Jeghers syndrome via STK11 mutation and usually lacks HPV association. Its prognosis is far worse than its bland appearance suggests. Villoglandular carcinoma occurs in younger women, carries a better prognosis and is HPV associated.

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.