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Omi M, Tanaka YO, Kurihara N, Sugiyama Y, Tonooka A, Kanno M, Fusegi A, Aoki Y, Netsu S, Abe A, Tanigawa T, Okamoto S, Nomura H, Kanao H. Preoperative diagnosis of cervical cystic lesions using magnetic resonance imaging: a retrospective study. BMC Womens Health 2024; 24:460. [PMID: 39160498 DOI: 10.1186/s12905-024-03304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/09/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND We conducted this study to clarify the magnetic resonance imaging (MRI) characteristics of lobular endocervical glandular hyperplasia (LEGH) and Nabothian cysts. METHODS This study included 48 patients who underwent hysterectomy at our institution between 2016 and 2020 for suspected LEGH. Histopathological studies confirmed the presence of 25 Nabothian cysts and 23 cases of LEGH. We retrospectively analyzed five characteristic MRI findings: (1) located at the upper cervical canal, (2) positioned within the cervical stroma, (3) not circumscribing the cervical canal, (4) low- to iso-intensity on T1-weighted images (T1WI), and (5) "cosmos" or "microcystic" pattern. We compared the diagnostic accuracy of these findings for LEGH and Nabothian cysts using sensitivity, specificity, and predictive values. Combinations of findings were also calculated. RESULTS The characteristics "cosmos" or "microcystic" pattern, lesion not circumscribing the cervical canal, and low/iso-intensity on T1WI had a sensitivity and specificity greater than 50%. The sensitivity was 73.9% and specificity 84.0% when a combination of "cosmos" or "microcystic" pattern and lesion not circumscribing the cervical canal was present. CONCLUSION The coexistence of a "cosmos" or "microcystic" pattern and not circumscribing the cervical canal was the most characteristic finding that distinguished LEGH from Nabothian cysts. When neither of these findings is present, Nabothian cyst can be suspected.
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Affiliation(s)
- Makiko Omi
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
| | | | - Nozomi Kurihara
- Department of Clinical Planning and Strategy, Cancer Institute Hospital, Tokyo, Japan
| | - Yuko Sugiyama
- Department of Cytology, Cancer Institute Hospital, Tokyo, Japan
| | - Akiko Tonooka
- Department of Pathology, Cancer Institute Hospital, Tokyo, Japan
| | - Motoko Kanno
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Sachiho Netsu
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Akiko Abe
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Terumi Tanigawa
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Sanshiro Okamoto
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
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Horibe Y, Kamoshida T, Takase R, Kashiwazaki S, Kanno T, Motohashi T, Akizawa Y, Nakabayashi A, Kumakiri J, Tabata T. The Utility and Feasibility of Laparoscopic Surgery in Patients Diagnosed With Cervical Cystic Lesions. Cureus 2024; 16:e64309. [PMID: 39130823 PMCID: PMC11316274 DOI: 10.7759/cureus.64309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
INTRODUCTION This observation study aimed to differentiate between lobular endocervical glandular hyperplasia (LEGH) and gastric-type mucinous carcinoma (GAS) while evaluating the feasibility and efficacy of laparoscopic surgery in the preoperative diagnosis of cervical cystic lesions. METHOD AND MATERIAL A retrospective study was conducted to evaluate the diagnostic process and laparoscopic surgical management of cervical cystic lesions suspected to be LEGH or GAS. Preoperatively and postoperatively, MRI, cytology, histology, tumor marker analysis, and surgical outcomes (blood loss during surgery, operative time) were assessed. Six individuals were selected based on magnetic resonance imaging (MRI) results indicating a preoperative suspicion of LEGH or GAS. These patients underwent laparoscopic surgical treatment without indications of malignancy based on preoperative histology or cytology. RESULTS Initially, all individuals were suspected to have LEGH based on MRI findings. Postoperatively, two patients were diagnosed with LEGH, two with adenocarcinoma in situ (AIS) and minimal deviation adenocarcinoma (MDA), and two showed no notable findings on pathology (one diagnosed endometrioid carcinoma in endometrial tissue). Patients with malignancies exhibited longer surgical times and higher intraoperative blood loss. Preoperatively, no significant variation was observed in maximal lesion diameter between adenocarcinoma and LEGH. However, lesion diameter increased significantly over time in patients with GAS. CONCLUSION Laparoscopic surgery demonstrated feasibility and provided crucial diagnostic and therapeutic outcomes, with no postoperative recurrence observed in cases of malignancy, despite the challenges associated with preoperative differentiation. These findings underscore the potential of laparoscopic surgery in enhancing both diagnostic accuracy and therapeutic efficacy for cervical cystic lesions, offering promise for improved patient outcomes and management strategies in clinical practice.
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Affiliation(s)
- Yu Horibe
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Tsukuru Kamoshida
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Ruriko Takase
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Sakie Kashiwazaki
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Toshiyuki Kanno
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Takashi Motohashi
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Yoshika Akizawa
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Akira Nakabayashi
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Jun Kumakiri
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Tsutomu Tabata
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
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Yoshino A, Kobayashi E, Tsuboyama T, Fukui H, Tomiyama N, Sato K, Morii E, Nakatani E, Komura N, Sawada I, Tanaka Y, Hori K, Yoshimura A, Takahashi R, Iwamiya T, Hisa T, Nishimura S, Kitai T, Yokota H, Shindo M, Miyata H, Hashimoto N, Sakiyama K, Abe H, Ueda Y, Kimura T. Novel Strategy for the Management of Cervical Multicystic Diseases. Ann Surg Oncol 2023; 30:2964-2973. [PMID: 36920588 PMCID: PMC10085883 DOI: 10.1245/s10434-022-13033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/13/2022] [Indexed: 03/16/2023]
Abstract
PURPOSE To investigate the clinical practices of diagnosing multicystic cervical lesions as a means to develop a more appropriate diagnostic algorithm for gastric-type adenocarcinoma (GAS) and its precursors. METHODS Clinical information for 159 surgically treated patients for multicystic disease of the uterine cervix was collected from 15 hospitals. We performed a central review of the MRI and pathological findings. The MRI findings were categorized into four types including two newly proposed imaging features based on the morphology and distribution of cysts, and the diagnosis accuracy was assessed. Among the four MRI types, types 1 and 2 were categorized as benign lesions that included LEGH; type 3 were precancerous lesions (with an assumption of atypical LEGH); and type 4 were malignant lesions. RESULTS The central pathological review identified 56 cases of LEGH, seven with GAS, four with another form of carcinoma, and 92 with benign disease. In clinical practice, over-diagnosis of malignancy (suspicion of MDA) occurred for 12/19 cases (63.2%) and under-diagnosis of malignancy occurred for 4/11 (36%). Among the 118 patients who had a preoperative MRI and underwent a hysterectomy, type 3 or 4 MRI findings in conjunction with abnormal cytology were positively indicative of premalignancy or malignancy, with a sensitivity and specificity of 61.1% and 96.7%, respectively. CONCLUSIONS Although the correct preoperative diagnosis of cervical cancer with a multicystic lesion is challenging, the combination of cytology and MRI findings creates a more appropriate diagnostic algorithm that significantly improves the diagnostic accuracy for differentiating benign disease from premalignancy and malignancy.
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Affiliation(s)
- Ai Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Takahiro Tsuboyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideyuki Fukui
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuaki Sato
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiji Nakatani
- Graduate School of Public Health (Medical Statistics), Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Naoko Komura
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Ikuko Sawada
- Department of Obstetrics and Gynecology, Itami City Hospital, Itami, Hyogo, Japan
| | - Yusuke Tanaka
- Department of Obstetrics and Gynecology, Osaka Rousai Hospital, Osaka, Japan
| | - Kensuke Hori
- Department of Obstetrics and Gynecology, Kansai Rousai Hospital, Amagasaki, Hyogo, Japan
| | - Akihiko Yoshimura
- Department of Obstetrics and Gynecology, Bell Land General Hospital, Osaka, Japan
| | - Ryoko Takahashi
- Department of Obstetrics and Gynecology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Tadashi Iwamiya
- Department of Obstetrics and Gynecology, Osaka General Medical Center, Osaka, Japan
| | - Tsuyoshi Hisa
- Department of Obstetrics and Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Sadako Nishimura
- Department of Obstetrics and Gynecology, Sumitomo Hospital, Osaka, Japan
| | - Toshihiro Kitai
- Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital Hyogo, Nishinomiya, Japan
| | - Hiromi Yokota
- Department of Obstetrics and Gynecology, Suita Municipal Hospital, Osaka, Japan
| | - Mariko Shindo
- Department of Obstetrics and Gynecology, Hannan Chuo Hospital, Osaka, Japan
| | - Hiromi Miyata
- Department of Obstetrics and Gynecology, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan
| | - Namiko Hashimoto
- Department of Obstetrics and Gynecology, Nippon Life Hospital, Osaka, Japan
| | - Kanako Sakiyama
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hazuki Abe
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Miyamoto T, Kobara H, Shiozawa T. Biology and management of lobular endocervical glandular hyperplasia. J Obstet Gynaecol Res 2022; 48:3056-3067. [PMID: 36177810 PMCID: PMC10092153 DOI: 10.1111/jog.15441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/13/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
AIM Lobular endocervical glandular hyperplasia (LEGH) is a multicystic proliferative disorder of the uterine cervix. The aim of this review was to clarify the current understanding of this unique tumor. METHOD This article reviews the chronological progress of research regarding clinico-pathological and genetic aspects of LEGH and related cervical cystic diseases such as Nabothian cyst and adenocarcinoma of gastric type (GAS), using the literature and data from our institute. We also describe clinical management including preoperative diagnosis and adequate surgical/expectant treatment based on the biological features. RESULTS Recent studies revealed several unique aspects of LEGH, that is, (i) production of gastric mucin, (ii) symptomatic and histological similarity with minimal deviation adenocarcinoma (MDA), and (iii) frequent association with GAS, including MDA. These findings indicated that LEGH is a gastric metaplasia, as well as pre-cancerous neoplasia. For the preoperative diagnosis of LEGH, the combination of "cosmos" sign on magnetic resonance imaging, detection of gastric mucin, and lack of nuclear atypia on cytology is important. Cone biopsy is effective for pathological diagnosis. Simple hysterectomy is indicated as surgical treatment for LEGH; however, meticulous follow-up is also an option, especially for young patients, because the rate of malignant transformation was reported to be 1%-2%. For LEGH patients who selected follow-up, a worsening cytology and increase in lesion size were important signs of malignant change of LEGH for safe follow-up. CONCLUSION Proper understanding of the characteristics of LEGH is important for adequate management.
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Affiliation(s)
- Tsutomu Miyamoto
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hisanori Kobara
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tanri Shiozawa
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
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