Mesonephric Adenocarcinoma Arising From The Uterine Corpus：Case Reports and Literature Review

Background Mesonephric adenocarcinoma (MNAC) is a rare carcinoma which arises from the mesonephric remnant of the gynecologic tract. It mainly occurs in the uterine cervix, barely locates in the uterine corpus, ovarian and vagina. To date, only a few cases of MNAC arising from of the uterine body (UB-MNAC) have been reported, and the clinicopathologic and molecular characteristics of UB-MNAC remain limited. A recent report suggested that series of UB-MNAC should be defined as Mesonephric-like adenocarcinoma carcinomas (MLAC), for they exhibited the classic morphologic features and immunophenotype of mesonephric carcinoma, but occurring outside of the cervix and without convincing mesonephric remnants. Thus, the histogenesis of UB-MNAC is not yet clear, they may originate in Müllerian tissue and exhibits the mesonephric differentiation phenotype, or arise from the mesonephric remnants in the uterine wall.Case presentation To better understand the histogenesis of UB-MNAC, we presented three UB-MNAC cases from west china second university hospital, which exhibited typical morphologic, histologic as well as the immunohistochemical characteristics of MNAC. Notably, among the three cases, two cases arising from the myometrium layer of the uterine corpus found mesonephric remnants around the tumor. By reviewing the published UB-MNAC and UB-MLAC, we found that to our knowledge ,it is the first time finding mesonephric remnants around the MNAC cells in the reported literature, except one case that found mesonephric remnants in the cervix, and the tumors of the three cases were all arising from the myometrium layer, without endometrium involved. Then we compared the clinical characteristics of the UB-MNAC cases arising from the myometrium and endometrium, and the results showed that the two subgroups had most in common in the clinical characteristics except the myometrium subgroup had a higher elevated CA125 level, and this result was in consistent with the Kaplan-Meier survival analysis, which indicated that the myometrium subgroup had a poorer prognosis than the endometrium group. But this need more data and further study such as the molecular analysis.Conclusion Though the pathogenesis of MLAC or MNAC of the uterine corpus is still under debate, according to our cases and the published literatures, We hypothesize two different pathways involved: the MNAC arising from the myometrium not affecting the endometrium may directly develop from the mesonephric remnant, the one occurred in the endometrium may not real mesonephric adenocarcinoma, but more likely arising from mesonephric transformation of Müllerian adenocarcinoma, and is better referred as MLAC. Besides, the two kinds of adenocarcinomas may have different clinical prognosis, while the MNAC arising from the myometrium may have a poorer prognosis than the MLAC originating from the endometrium, although they have identical morphologic and histologic characteristics.

Carcinosarcoma of the uterine cervix: a rare pathological finding originating from mesonephric remnants

Carcinosarcoma of the uterine cervix is a very rare tumour that has been described in less than 70 cases in the literature. It is less common compared with carcinosarcoma of the uterine corpus and it can have two origins: the Müllerian ducts and the mesonephric duct remnants. The association of mesonephric carcinoma with a sarcomatous component was reported in only 11 cases, including the following. We describe a case of a 64-year-old woman, presenting with vaginal bleeding and a cervical lesion reported as a sarcoma of endometrial stroma in the first biopsy. After exclusion of distant disease, she was submitted to radical surgery and the final histopathological examination showed a carcinosarcoma of the cervix with mesonephric origin.

Diagnostic dilemma of mesonephric adenocarcinoma cervix

Introduction: Mesonephric carcinoma is a rare type of epithelial tumor of the uterine cervix which derive from the remnants of the paired mesonephric (Wolff’s) ducts. The incidence of such neoplasms is difficult to determine due to rarity, previous misclassification of clear cell carcinomas and yolk sac tumours as mesonephric carcinomas and potential underreporting due to misclassification of mesonephric carcinoma as Mullerian tumours or mesonephric hyperplasia. The evidence regarding the clinical course, prognosis and optimal treatment is limited. Materials and Methods: Searches were performed on MEDLINE, EMBASE and Google Scholarly articles. All the relevant articles were included in the study. Only approximate 40 cases have been reported till now. Discussion: Mesonephric adenocarcinoma cervix has different morphologies like ductal, tubular, solid, retiform, sex-cord like pattern, clear cell and serous papillary structures. IHC assessment is helpful in differentiating it from Mullerian counterpart, as it is negative for CEA, CK20, p16, PAX2, ER/PR and vimentin and positive for CD10, calretinin, CK7, CAM5.2 and EMA. It has no relation with HPV infection. Unlike squamous epithelial carcinoma, it is rarely presenting with the abnormal cervical smear result, has more advanced age at presentation and its incidence does not appear to decline with age. The diagnosis has been supported by endometrial curettings, directed/cone cervical biopsies and hysterectomy specimens. The majority of patients are diagnosed at stage IB with mean DFS of 48.6 months. Recurrence rate is 23%, with a mean interval of 40 months. Hysterectomy is the primary treatment. Advanced stage disease of adenocarcinoma seemed to respond to radiotherapy, but for the MMMTs the combination of chemotherapy with radiotherapy appears to be preferable. Conclusion: Rarity of the neoplasm, varied morphology, mix presentation and very low number of cases leads to difficulty in correct diagnosis in a small biopsy specimen. IHC helpful in differentiating it from other lesions.