When cervical microglandular hyperplasia coincides with high-risk human papillomavirus infection: Diagnostic challenges and evidence

Abstract

ABSTRACT Cervical microglandular hyperplasia (MGH) is a benign cervical lesion mimicking cervical malignancy, thereby making its pathogenesis diagnostically challenging for gynecologists and pathologists. While MGH is often associated with physiological or external hormonal factors, several cases remain unexplained. In this report, we present a case of a young primiparous woman without evident hormonal risk factors seeking gynecologic evaluation owing to abnormal vaginal discharge. During her clinical examination, we observed an irregular cervical lesion raising malignancy-related concerns and consequently planned a colposcopy. The human papillomavirus (HPV) polymerase chain reaction tested positive for two high-risk HPV genotypes (16 and 52), denoting that the patient did not have an HPV infection history. During colposcopy, we identified a friable papillary cervical mass at the transformation zone, bleeding significantly with minimal handling, from which we obtained multiple biopsies. Our subsequent histopathological examinations eventually confirmed the MGH diagnosis, ruling out malignancy. Intriguingly, a follow-up colposcopy 7 months later revealed the resolution of the initial cervical lesion, coinciding with negative HPV test and Pap smear cytology results. This case highlights the rare encounter of MGH concurrent with an initial high-risk HPV infection. Beyond a comprehensive review of related literature and clinical guidelines, we discuss the clinical and histopathological results in such a case.