A 38-year-old woman presents with profuse watery vaginal discharge. Imaging reveals a barrel-shaped cervix. Microscopy shows bland-looking glands deeply infiltrating the cervical wall with minimal cytologic atypia. Immunohistochemistry shows gastric-type differentiation with HIK1083 and MUC6 positivity. What is the diagnosis?
- A Endocervical adenocarcinoma, usual type (HPV-associated)
- B Minimal deviation adenocarcinoma (adenoma malignum) ✓
- C Endometrioid carcinoma of the cervix
- D Clear cell carcinoma of the cervix
Correct answer: B. Minimal deviation adenocarcinoma (adenoma malignum)
Explanation
Minimal deviation adenocarcinoma (adenoma malignum) is a gastric-type endocervical adenocarcinoma with deceptively bland glands infiltrating deep into the cervical wall. It is HPV-negative and associated with Peutz-Jeghs syndrome. The barrel-shaped cervix and watery discharge are classic. Unlike usual endocervical adenocarcinoma (HPV/p16 positive), it shows gastric differentiation markers (MUC6, HIK1083) and has a worse prognosis due to deep invasion and advanced stage at presentation.
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.