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Colposcopic Features of Microglandular Hyperplasia of the Uterine Cervix
V. Cecil Wright, MD, FRCS(C), FACOG

Introduction

Microglandular hyperplasia (MGH, also termed microglandular endocervical hyperplasia) was first described in 1967 by Taylor et al.1 These authors noted atypical endocervical hyperplasia in women taking oral contraceptives. The condition was later described as a florid example of reserve cell hyperplasia with glandular differentiation in response to hormone (predominantly progesterone) stimulation.2 It was reported in premenopausal women using oral contraceptives and during pregnancy but was unusually observed in postmenopausal women.2-5 However, later studies indicated that progesterone, estrogen or their combination were not always implicated.2,6,7 The diagnosis is most frequently made as an incidental microscopic finding on endocervical tissue from sampling (biopsy, excision, hysterectomy).

Although florid, globular expressions occur, they are not common and in this author’s experience they are usually pregnancy-related. Colposcopically, they appear as fusiform, globular, villous-like masses that are located predominately over endocervical columnar epithelium and not necessarily in contact with the squamous border. On occasion, the polypoid globular masses resemble large polyps. The areas are easily traumatized with resultant bleeding, however blood vessel patterns are not a prominent colposcopic feature. What appears to be characteristic is a yellow hue (similar to the color of chicken fat) that is better seen before the application of acetic acid. Florid or papillary MGH lesions mimic glandular lesions (adenocarcinoma in situ and adenocarcinoma).8 They shed atypical glandular cells. Consequently MGH can be a challenge for the colposcopist.

Figures 1 to 6 illustrate the colposcopic features of MGH. There are reliable colposcopic features of the condition, although this is not widely recognized due to the rarity of its clinical presentation at colposcopy. All figures are views before acetic acid except the final one. Note that after acetic acid the yellowish hue is not appreciated (Figure 6).

Figure 1. Fused villous-like masses of varying sizes involving the endocervical canal and ectocervical columnar epithelium. Note the yellow hue. Colposcopically, blood vessels are not a predominant feature despite the small areas of bleeding from minimal trauma.
Figure 2. Fused papillary masses of MGH. The individual columnar villi become enlarged and vary in size. Note the yellow hue.
Figure 3. Large yellow-appearing, fused globular masses of MGH involving the endocervical canal’s columnar epithelium. The areas bleed easily with minimal trauma.
Figure 4. Faint yellow polypoid masses of MGH in a cervix at 36 weeks gestation. Blood vessels are not a prominent feature.
Figure 5. Large, polypoid masses of MGH mimicking an adenocarcinoma shown before acetic acid. Note the yellow hue. The area borders on immature, metaplastic ectocervical tissue that exhibits a reverse mosaic (pseudomosaic) vessel pattern. The lesion bleeds easily with trauma.
Figure 6. A lower magnification of Figure 5 shown after acetic acid demonstrating the extensiveness of the lesion. The patient was postpartum and presented to the colposcopy clinic as a consequence of a Pap smear showing atypical glandular cells.

Credits

All images are from Wright VC. Comprehensive Colposcopy Review: Cervix, Vagina, Vulva and Adjacent Sites CD-ROM. Houston: Biomedical Communications, 2008, reproduced with permission of the publisher.

Read the second Master Colposcopy Article- What is Your Colposcopic Impression?

References
1. Taylor HB, Irey NS, Norris HL. Atypical endocervical hyperplasia in women taking oral contraceptives. JAMA 1967;202:637-9.
2. Chamas JC, Nelson B, Mann WJ, et al. Microglandular hyperplasia of the uterine cervix. Obstet Gynecol 1985;66:406-9.
3. Kyriak M, Kempson RL, Konikov NF. A clinical and pathologic study of endocervical lesions associated with oral contraceptives. Cancer 1968;22:99-110.
4. Candy MD, Abell M. Progesterone-induced adenomatous hyperplasia of the uterine cervix. JAMA 1968;203:323-6.
5. Govan ADT, Black WP, Sharp JL. Aberrant glandular polyp of the uterine cervix associated with contraceptive pills:
Pathology and pathogenesis. J Clin Pathol 1969;22:84-9.
6. Wilkinson E, Dufour R. Pathogenesis of microglandular hyperplasia of the cervix uteri. Obstet Gynecol 1976;47:189-95.
7. Greeley C, Schroeder S, Silverberg SG. Microglandular hyperplasia of the cervix: A True “Pill Lesion”. Int J Obstet Gynecol 1995;14:50-4.
8. Wright VC. Colposcopy of cervical polyps, cysts, fibroids, microglandular hyperplasia, DES and miscellaneous conditions. In Wright VC. Comprehensive Colposcopy Review: Cervix, Vagina, Vulva and Adjacent Sites CD-ROM. Houston: Biomedical Communications, 2008.

Editors:
Thomas F. Purdon, MD, FACOG

Clinical Professor of Obstetrics and Gynecology
Department of Obstetrics and Gynecology
University of Arizona Health Sciences Center, Tucson, Arizona
Consultant, United Community Health Centers of Arizona

Kenneth D. Hatch, MD
Professor of Obstetrics and Gynecology
Head, Division of Gynecologic Surgery
University of Arizona College of Medicine, Tucson, Arizona

V. Cecil Wright, MD, FRCS(C), FACOG
Professor Emeritus in the Department of Obstetrics and Gynaecology
Schulich School of Medicine and Dentistry
University of Western Ontario.

He subspecialized in surgical gynecologic oncology. He has published extensively in the peer-reviewed literature and has contributed chapters to a variety of textbooks and developed numerous CDs on colposcopy and lower genital tract disease. He has taught at hundreds of postgraduate courses. He has lectured in over 30 different countries (some of them many times).

Dr. Wright has received national and international scientific awards, most notably the American Society for Colposcopy and Cervical Pathology’s Distinguished Scientific Achievement Award and his university’s Dean’s Award of Excellence for Innovation in connection with his introduction of carbon dioxide laser surgery to gynecology in Canada. He was honored with ACOG’s Commemorative Medal for Excellence in Teaching. Dr. Wright’s department recently established the V. Cecil Wright Lecture to be given at its annual oncology day.

Recently, Dr. Wright served as the colposcopy trainer for GlaxoSmithKline Biologicals – Belgium in their standardization program for the phase III trials of their HPV vaccine. He has been an educational consultant and provider of educational materials to Merck Frosst Canada regarding the development of their HPV vaccine. Dr. Wright continues writing, teaching, and serving as an invited speaker.