Progestogen-Induced Adenomatous Hyperplasia of the Uterine Cervix

Abstract

A distinctive adenomatous and cribriform hyperplasia of gland and reserve cells of the uterine cervix is attributed to progestogens. The lesions were polypoid or verrucose and located near the squamocolumnar junction. Carcinoma was usually suspected on clinical examination, and on biopsy the diagnosis of adenocarcinoma was either made or seriously entertained for seven of 12 patients. The natural history of the lesion does not indicate any likelihood of progression to carcinoma.Several groups of workers have referred briefly to the effects of progestogens on the human uterine cervix.13 The observed changes were hypersecretion, hyperplasia of glandular epithelium, and stromal edema. They were considered to be similar to but not as intense as those observed during preg¬ nancy. None of the investigators reported severe or atypical hyperplasia of endocervical epithelium.During the past four years we have encountered several examples of a distinctive hyperplasia of glandular epithelium in the cervices of women re¬ ceiving progestogens. In several instances, errone¬ ous diagnoses of adenocarcinoma were made ini¬ tially from biopsy specimens. Although our series of cases is small and the periods of observation short, there is no evidence to suggest that the lesion is anything but benign. The main purpose of this re¬ port is to acquaint those concerned with the inter¬ pretation of biopsy specimens with this particular cervical lesion, as the consequences of overdiagnosis in young women, in whom it predominates, are serious. Materials and MethodsAll biopsy specimens of uterine cervix examined which exhibited adenomatous or atypical gland cell hyperplasia were as¬ sessed. Specimens from 12 patients showed a dis¬ tinctive and florid adenomatous hyperplasia. In material from several additional patients, minor de¬ grees of a similar change were noted, but only those specimens in which the hyperplasia was marked and unquestionable were accepted for study. Clini¬ cal records of the patients were reviewed and particular attention directed to the assessment of presenting symptoms, gross appearance of cervix, hormonal medication, subsequent treatment, and survival.Tissue specimens were stained routinely with hematoxylin and eosin. In most instances addi¬ tional material was on hand so that a variety of special histologie stains were employed, including alcian green and mucicarmine stains for mucus,

Color Atlas of Histopathology of the Cervix Uteri

“…Occasionally a solid sheetlike proliferation of reserve cells, signet-ring cells or hobnail cells may be observed. These changes, too, may be misdiagnosed as invasive adenocarcinoma or clear cell carcinoma (Taylor et al 1967;Candy and Abell 1968;Kyriakos et al 1968;Talbert and Shery 1969;Helmerhorst et al 1984;Wells and Brown 1986;.…”

Hormonal Steroid Contraceptives1 IV

“…Taylor et al (1967) described what they considered to be a distinctive, polypoid endocervical hyperplasia which they had been seeing with increasing frequency and only in women taking oral progestagens, usually as oral contraceptives. Candy and Abell (1968) similarly considered that appearances they described in women on oral contraceptives constituted a specific entity, and Govan et al (1969) described an unusual polypoid condition of the cervix. Wied et al (1966) failed to find a significant incidence of atypical changes in cervical smears from a group of about 1,600 women on oral contraceptives, but Attwood found a 2.2 % incidence of dysplasia in smears from 500 women on oral contraceptives, as against 0.8 % for 9,000 controls.…”

Hormonal Steroid Contraceptives1 II

“…These changes are sometimes mistaken either for an infective process or for carcinoma. Despite the occasional appearance of atypical changes in the cervical epithelium there is no evidence that the prevalence of neoplasia of the cervix is higher in users of oral contraceptives than in women using other forms of contraception (Candy and Abel, 1968;Melamed et al, 1969;Taylor et al, 1967) .…”