Early identification of atypical lobular endocervical glandular hyperplasia: a case series

Atypical lobular endocervical glandular hyperplasia (ALEGH) is a recognized pre-malignant lesion of the gastric-type adenocarcinoma (GAS). Its diagnosis is challenging due to non-specific symptoms, frequent false-negative cervical screening, and the lack of established management guidelines. We present two cases that illustrate the diagnostic and management approach to ALEGH. The first involved a 53-year-old postmenopausal Asian woman with watery discharge and bleeding. Her ThinPrep cytologic test (TCT) showed atypical glandular cells. She underwent resection of cervical vegetation, and pathological examination of the specimen confirmed atypical lobular endocervical glandular hyperplasia of the cervix. The second was a 47-year-old premenopausal Asian woman with discharge and irregular bleeding. Initial cervical screening was unremarkable, while cervical biopsy revealed high-grade squamous intraepithelial lesion. Subsequent imaging evaluation and diagnostic cervical conization were performed and the final diagnosis was LEGH with focal atypia. Both underwent laparoscopic total hysterectomy and bilateral salpingo-oophorectomy and have remained disease-free. It is crucial that clinicians have a thorough understanding of ALEGH as a precancerous lesion of GAS, to enable its early recognition and intervention and prevent progression to invasive cancer.