Adenomyomas of the uterine cervix: report of a case series of endocervical type and the first report of a mesonephric adenomyoma cohort including endocervical and novel variants

Aims: To report a series of 10 cervical adenomyomas of endocervical type and the first case of a mesonephric adenomyoma. Methods and results: The patients' ages ranged from 30 to 55 years. Most lesions were grossly polypoid; a minority were intramural or exophytic. In six of seven endocervical adenomyomas received in consultation, adenoma malignum was considered. A variety of benign lesions, including lobular endocervical glandular hyperplasia (LEGH), adenofibroma, endocervicosis and tunnel clusters, were also considered. The endocervical adenomyomas consisted of bland mucinous glands, sometimes with focal epithelial metaplasia, within a prominent smooth muscle stroma. There was usually a focal lobular architecture and sometimes papillary infoldings. A characteristic feature was a rim of stroma surrounding glands, surrounded in turn by smooth muscle. Previously undescribed features were 'symplastic-like' smooth muscle, stromal adipose tissue, gland rupture with mucin extravasation, prominent adenofibroma-like areas and surface cervical intraepithelial neoplasia (CIN). Diffuse oestrogen receptor (ER) immunoreactivity was useful in excluding adenoma malignum and LEGH, which are hormone receptor-negative. The mesonephric adenomyoma consisted of a lobular arrangement of mesonephric glands [ER/progesterone receptor (PR)-negative; vimentin and luminal CD10 immunoreactivity] within a smooth muscle stroma. Conclusions: Endocervical and mesonephric adenomyomas are rare lesions which are often misdiagnosed, possibly because of lack of familiarity among pathologists.