Papillary immature metaplasia (immature condyloma) of the uterine cervix: A report of three cases in postmenopausal women and review of the literature

Papillary immature metaplasia (PIM) of the uterine cervix is an uncommon low-grade exophytic papillary squamous intraepithelial lesion characterized by immature metaplastic morphology. It typically involves the proximal transformation zone, often extending into the endocervical canal, and has been reported almost exclusively in premenopausal women. PIM is poorly recognized, partly because it is not included as a distinct entity in the current WHO classification of tumors. Because of its proximal location, papillary architecture, and morphologic immaturity, PIM can pose significant diagnostic challenges, particularly in postmenopausal patients. Three cases of PIM occurring in postmenopausal women were described, and a review of the literature was performed. All three cases showed typical histopathologic features of PIM; notably, two patients presented with postmenopausal bleeding and underwent repeated endometrial sampling. Among these three cases, only one case tested positive for low-risk HPV infection based on the available testing panels. Immunohistochemically, all three lesions showed diffuse GATA3 expression, suggesting its potential utility as an adjunctive marker for PIM. Review of literature shows it occurs almost exclusively in premenopausal women presenting with abnormal screening cytology or a cervical mass. Most cases (77%) are associated with low-risk HPV, predominantly types 6 and 11, and demonstrate a low Ki-67 proliferation index. PIM is a poorly recognized, low-grade papillary proliferative lesion of the uterine cervix associated with low-risk HPV infection. We report three cases of PIM in postmenopausal patients to increase awareness and improve recognition of this entity, thereby helping prevent both overdiagnosis and underdiagnosis.