Microglandular Hyperplasia of the Cervix - Understanding and Implications

What Is Cervical Microglandular Hyperplasia?

Microglandular hyperplasia (MGH) of the cervix presents with multiple growths of glandular cells within the endocervical tissue of the cervix. These growths are usually non-cancerous. It can sometimes be diagnosed as an incidental microscopic finding in the reproductive females. This condition was first described in 1967 by Taylor HB et al. in young females. This article further highlights the epidemiology, causes, histopathological presentation, diagnosis, and management of microglandular hyperplasia of the cervix.

What Is the Epidemiology of Cervical Microglandular Hyperplasia?

Microglandular hyperplasia of the cervix is more common in females of reproductive age.

It mostly affects females in the age group of 30 to 60 years.

What Are the Causes of Cervical Microglandular Hyperplasia?

The causes of microglandular hyperplasia of the cervix are:

• Alteration in endogenous hormones due to pregnancy, hormonal therapy, or gynecological treatment.

• Women on oral contraceptive medications result in hormonal imbalance.

• Women with a history of HRT (hormone replacement therapy).

• Postmenopausal females.

What Are the Histological Features of Cervical Microglandular Hyperplasia?

The histological features of cervical microglandular hyperplasia are often difficult to differentiate from a histological presentation of adenocarcinoma, making an accurate diagnosis difficult for the doctor. A few notable macroscopic features of cervical microglandular hyperplasia are

• Glandular proliferation (proliferation or growth of glandular cells of the cervix).

• Small and crowded glands with a high density of cells as compared to that of normal tissues of the cervix.

• Squamous metaplasia of the cervix (non-cancerous changes in the cells and tissue lining the cervix).

• Glandular spaces are dilated or round and mold on each other, presenting a cribriform effect (pierced with multiple holes-like effects).

• Increased number of vacuolated cells (mostly mistaken as clear cell carcinoma).

• Loose and edematous stroma showing acute inflammation (swelling).

• A cluster of reserve cells around the glandular growth.

• Single or multiple polypoid masses are usually observed.

• The presence of endocervical polyps can be observed.

• Presence of mucin intraluminally.

• Signet or hobnail cells are distinguishing and characteristic features.

What Are the Signs and Symptoms of Cervical Microglandular Hyperplasia?

Microglandular hyperplasia (MGH) of the cervix shows the following clinical features:

• Asymptomatic: The condition is usually asymptomatic and is observed during routine microscopic examination.

• Irregular Menstrual Bleeding: The affected females present with abnormal or unexpected bleeding in between the menstrual periods.

• Postcoital Bleeding: Some women with this condition may experience postcoital bleeding (bleeding after sexual intercourse).

As clinical presentation might be subtle or absent, the condition is often found incidentally during routine examinations. Any abnormalities detected during routine gynecological examinations, pap smears (a procedure in which a small brush is used to remove cells from the cervix's surface gently), or biopsies would prompt further investigation and diagnosis by a healthcare professional.

How Is Cervical Microglandular Hyperplasia Diagnosed?

The following diagnostic criteria are used to rule out microglandular hyperplasia of the cervix:

• History and Clinical Examination: The doctor should record a detailed history of the individual for the presence of underlying symptoms, history of hormone replacement therapy, and use of contraceptive agents to rule out the condition.

• Abnormal Pap Smear: Microglandular hyperplasia of the cervix may be detected through abnormal results in pap smears or cervical biopsies - a sample of diseased tissue collected from the cervix region surgically and sent to the laboratory for pathological interpretation to rule out the exact diagnosis.

What Is the Treatment of Cervical Microglandular Hyperplasia?

Microglandular hyperplasia (MGH) of the cervix is a benign or non-cancerous condition, and specific treatment for MGH itself is usually not necessary. Since MGH is typically diagnosed incidentally during routine gynecological examinations or screenings, and it does not pose a significant health threat, a healthcare provider may choose to monitor the condition over time without specific interventions. In cases where affected women present with any clinical signs and symptoms, it can be managed symptomatically with a customized approach. The treatment is only advocated when a patient presents with symptoms, and management is further advocated based on the patient's specific circumstances. Doctors usually advise the maintenance of good personal hygiene. Regular follow-up with the specialist is recommended to monitor any malignant changes in the growth to ensure the absence of malignancy.

What Is the Differential Diagnosis?

The diagnosis of microglandular hyperplasia (MGH) of the cervix is often confused with conditions like

• Endocervical adenocarcinoma (cancer of glandular cells).

• Premalignant glandular changes.

• Clear cell carcinoma of the cervix (rare cancer with clear cells in the tumor).

The pathologists (a specialist who examines body tissues) are advised to note the key pathological and clinical features of the microglandular hyperplasia of the cervix to avoid misinterpretation or delay in diagnosis of the condition as it has a quite similar histological pattern to adenocarcinoma and other premalignant glandular lesions which makes it the diagnosis challenging.

Conclusion

Microglandular hyperplasia of the cervix is a non-cancerous condition characterized by the abnormal growth of glandular cells in cervical tissue. While it is considered benign, its microscopic resemblance to more serious lesions necessitate accurate diagnosis through methods such as immunohistochemical staining. Despite its non-malignant nature, proper monitoring and follow-up are crucial to rule out underlying malignant conditions. Regular gynecological examinations and consultations with healthcare providers are essential for individuals diagnosed with microglandular hyperplasia of the cervix.