Abstract
BACKGROUND: Atypical lobular endocervical glandular hyperplasia is an infrequent precursor to gastric-type cervical adenocarcinoma, often posing diagnostic challenges owing to its occult nature and high misdiagnosis rate. The synchronous presentation in both the cervix and endometrium, a form of synchronous mucinous metaplasia and neoplasia of the female genital tract, is even rarer. CASE PRESENTATION: We report the case of a 53-year-old Chinese woman with increased vaginal discharge and postmenopausal bleeding, initially misdiagnosed as cervical and endometrial polyps. Postoperative pathology following hysteroscopy revealed synchronous atypical lobular endocervical glandular hyperplasia of the cervix and endometrium. Notably, while atypical lobular endocervical glandular hyperplasia is typically an occult finding diagnosed after cervical conization, hysteroscopy in this case enabled direct visualization and targeted biopsy, overcoming a significant diagnostic hurdle. CONCLUSION: This case underscores the insidious clinical presentation of synchronous atypical lobular endocervical glandular hyperplasia and highlights the pivotal role of hysteroscopy as a diagnostic tool. It can facilitate the early and accurate identification of these occult lesions, thereby preventing potential misdiagnosis and guiding appropriate management.