Although still rare if compared with the squamous lesions of the uterine cervix, pre-malignant and malignant lesions of the endocervical glandular epithelium seem to be increasing [19, 59]. This development maybe partially the result of the decrease in the number of cases of invasive squamous cell carcinoma and cervical intraepithelial neoplasia (CIN), but there is also evidence for an absolute (not only relative) increase in some countries, particularly among young women [19]. As to the etiology, there is compelling evidence that - as in squamous lesions - that infection with HPV is a necessary initial event in the process of carcino-genesis. The occasional occurrence of carcinoma in situ of mixed, squamous and glandular types in close association supports this hypothesis. Interestingly, the spectrum of HPV-types seems to differ in that type 18 appears to be the most common virus found. As cofactors, hormonal influences have been postulated, in particular the long-term use of oral contraceptives. Whether this is of any significance is still debated.
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