Minimal deviation adenocarcinoma of the cervix in a patient with a high-grade cervical squamous intraepithelial lesion: case report and review of the literature.

Minimal deviation cervical adenocarcinoma, otherwise known as adenoma malignum, is a rare and particularly well differentiated type of cervical adenocarcinoma, and is often misdiagnosed because of its benign-looking histological features. Adenoma malignum represents only 1-3% of all cervical adenocarcinomas. The Papanicolaou smear as well as punch biopsies can fail in the detection of adenoma malignum. We present the case of a 55-year-old woman diagnosed as having microinvasive minimal deviation of the adenocarcinoma cervix, after conisation for a high-grade cervical squamous intraepithelial lesion. The patient was referred for an abnormal pap smear to our colposcopy clinic where the punch biopsies performed failed to diagnose the disease. The consequent cone biopsy because of CIN3, provided us with a definite diagnosis of adenoma malignum. Subsequently, the patient underwent a radical hysterectomy and pelvic lymph node dissection. The histologic examination was normal. Coexistence of a squamous intraepithelial lesion with adenoma malignum is extremely uncommon.