Progressive MRI changes in lobular endocervical glandular hyperplasia suggesting malignant transformation: report of two cases with histopathologic correlation.
Takahito Niiyama, Aki Kido, Hideto Kawabe et al.
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Case in brief
Two premenopausal women with previously diagnosed lobular endocervical glandular hyperplasia (LEGH) underwent serial MRI follow-up and were subsequently found to have minimal deviation adenocarcinoma (MDA) associated with LEGH. In both, the T2-weighted MRI cosmos pattern showed progressive enlargement of a central hypointense area and shrinkage of surrounding cysts, without apparent overall lesion growth. Cytology remained negative for intraepithelial lesion or malignancy. Hysterectomy specimens showed infiltrative or deeply extending glands with reactive fibrotic stroma; this stroma corresponded to the central hypointense MRI area.
What made this case unusual
The central low-signal area enlarged while peripheral cysts shrank, despite no apparent increase in overall lesion size or worsening cytology. Histopathology linked the central area to reactive fibrotic stroma associated with invasive glands.
Diagnostic / clinical pearl
In LEGH under MRI surveillance, assess changes in the internal cosmos pattern: progressive central T2 hypointensity with shrinking peripheral cysts may signal associated MDA even when lesion size and cytology appear unchanged.