Adenoma malignum der Zervix uteri

Adenoma malignum of the cervix, also referred to as minimal deviation carcinoma / minimal deviation adenocarcinoma, is considered a rare variant of cervical mucinous adenocarcinoma.


It is thought to represent ~1-3% of all cervical adenocarcinomas. It can present in a wide age group (~25-70 years) peaking at around 42 years .

Clinical presentation

Common presenting symptoms are menometrorrhagia, vaginal (often watery) discharge, postmenopausal bleeding and abdominal swelling.


It is considered a rare variant of well-differentiated mucinousadenocarcinoma of the uterine cervix. Multiple irregular lobulations of distorted glands demonstratinga "hairpin" shape are considered a characteristic pathological feature .

Microscopic examination often shows glands which are irregular in size and shape and lined predominantly by mucin-containing columnar epithelial cells with basal nuclei.


Radiographic features


Enlarged globular cervix with multilocular cystic (grape-like clusters), multilocular cystic with solid components or predominantly solid on ultrasound. The solid lesions are usually heterogeneous in echogenicity. Color Doppler interrogation usually show moderate or abundant color content .


May be seen as multiple cystic lesion containing variably sized solid portions extending from the endocervical gland to the deep stroma of the cervix.

Reported signal characteristics include:

  • T1: isointense (majority) to slightly hyperintense relative to the uterus
  • T2: markedly hyperintense relative to the uterus
  • T1 C+ (Gd): solid components show contrast enhancement

Treatment and prognosis

The overall prognosis has been reported to be unfavorable due to dissemination into the peritoneal cavity even at an early stage of the disease due to response to radiation and/or chemotherapy being poor.

History and etymology

It is thought to have been first described by Gusserow in 1870.

Differential diagnosis 

Considerations for a cystic multilocular cervical lesion (especially on MRI) include:

  • pseudoneoplastic glandular lesions
    • tunnel cluster : usually show no cervical enlargement, no solid component, no increased color Doppler flow and doesn't invade stroma
    • endocervicalglandular hyperplasia 
    • deep Nabothian cysts 
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