Atypical oxyphilic metaplasia of the endocervical epithelium: A report of six cases

We report six examples of a hitherto undescribed atypical metaplastic change of the endocervical glandular epithelium that we have designated atypical oxyphilic metaplasia of the endocervical epithelium. The patients ranged in age from 41 to 62 (mean 47.8) years; one was postmenopausal. Gravidity ranged from one to five (mean 2.8) and parity from one to four (mean 2.7). At the time of diagnosis one patient was taking combined oral contraceptives and one was taking tamoxifen for breast cancer. All of the lesions were incidental findings and were unassociated with a gross abnormality. Microscopically, affected endocervical glands were lined by large cuboidal or polygonal epithelial cells with dense, eosinophilic, focally vacuolated cytoplasm and varying degrees of nuclear atypia. Nuclei were enlarged, hyperchromatic, and frequently multilobated or multinucleated. Rare apical snouts were present in two cases. Stratification and mitotic activity were absent. Rare, focal periodic acid-Schiff positivity with and without diastase predigestion was present in three of three cases. Mucin staining was negative in two of three cases and focally stained luminal secretions in one of three cases. Three of three cases were negative for GCDFP-15 and carcinoembryonic antigen. Meaningful follow-up in four patients ranged from 1 to 15 (mean 5.5) years and was uneventful in all of them. Atypical oxyphilic metaplasia of endocervical epithelium represents yet another benign endocervical glandular atypia that must be distinguished from more serious lesions.