Morular metaplasia misdiagnosed as adenoacanthoma in young women with polycystic ovarian disease

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Abstract
Five cases of polycystic disease of the ovaries are presented; in 4 cases the diagnosis of adenoacanthoma was made from an endometrial biopsy. The age range was 24-37 yr. The 5th case had been called atypical glandular hyperplasia. In 4 of the 5 patients salpingoophorectomy and hysterectomy were performed; the hysterectomy specimens showed no evidence of hyperplasia or carcinoma. Consultation review of the slides revealed morular metaplasia as well as tubal metaplasia. In 1 case, mucinous metaplasia was also present. Morule formation may distend glands and compress surrounding uninvolved endometrium, resulting in a pattern of back-to-back glands, that are often lined by a single layer of columnar epithelium and should not be confused with back-to-back glands seen in adenomatous hyperplasia or adenocarcinoma. In both conditions, the epithelium is stratified and shows nuclear atypism. Morules, especially when they coalesce, can be misconstrued as adenoacanthoma; however, the cells are uniform and bland in appearance.

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