Tumours of the uterine cervix that can be underdiagnosed or misinterpreted

There are three major problems in the pathological interpretation of cervical cancers. First, the problem of underdiagnosing some malignant tumours such as squamous carcinoma with CIN3-like growth pattern, as CIN3 with possible early micro-invasion; minimal deviation adenocarcinoma, as normal endocervical or tuboendometrial glands; villoglandular adenocarcinoma, as villoglandular adenoma, adenoid basal carcinoma as embryonic rests; papillary squamotransitional cell carcinoma, as squamous papilloma; or the rare extra-uterine endometrial stromal sarcoma with predominant glands, so-called aggressive endometriosis, as endometriosis. Second, the difficulty in deciding whether a malignant tumour found in the cervix is of a primary cervical endometrial origin. Third, the problem of misinterpreting some unusual non-epithelial malignant tumours as undifferentiated carcinomas of other forms of sarcomas. These include epithelioid and myxoid leiomyosarcoma, alveolar rhabdomyosarcoma and malignant melanoma. In this review, the importance of recognizing these lesions is emphasized in order to ensure proper patient management and prognostication.