Geburtshilfe Frauenheilkd 2019; 79(06): e16
DOI: 10.1055/s-0039-1692084
Abstracts
Georg Thieme Verlag KG Stuttgart · New York

Mesonephric-like Adenocarcinoma of the Endometrium with KRAS-Mutation – Report of a Case and Literature Review

LC Horn
1   Institute of Pathology, Division of Breast Gynecologic & Perinatal Pathology, University Hospital of Leipzig
,
C Billing
1   Institute of Pathology, Division of Breast Gynecologic & Perinatal Pathology, University Hospital of Leipzig
3   Institute of Pathology, Division Molecular Pathology, University Hospital of Leipzig
,
K Herrmann
2   Institute of Pathology, City Hospital Bremen
,
T Unger
3   Institute of Pathology, Division Molecular Pathology, University Hospital of Leipzig
› Author Affiliations
Further Information

Publication History

Publication Date:
22 May 2019 (online)

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Objective:

Very rarely mesonephric-like features are seen in ACs of the endometrium and account for about 1% of all endometrial AC. Here we report three cases with clinical, histopathological and molecular analyses.

Methods:

Case description with immunohistochemical and molecular analyses. Review of the literature of mesonephric-like AC of the endometrium for porgnosis.

Case Report:

Three consecutive cases represented with postmenopausal bleeding with a mean age of 66.3 years (tange 61 – 74 years). ON curretting a endometrioid carcinoma G1/G2 was diagnosed. The patients were treated with total hysterectomy and BSO. On the hysterectomy specimen, there was a mixture of endometrioid-like cells and cuboidal cells with abrupt transition. There was a negative reaction against CK 7, TTF-1, ER, PR, CDX-2, CD 10, Inhibin and HNF-1β, but positivity against calretinin (focal staining), vimentin, CEA (apical cytoplasmic), PAX-8, p16 (patchy), p53 (wild type staining). MSI-proteins were positive. Pyrosquencing represented an activating KRAS-point mutation p.G12V at codon 12 in all cases but no mutations within PI3KCA and p53.

Conclusion:

There are lower than 30 endometrial AC with mesonephric-like features (ML-AC) described in the literature. Including the present ones, the majority of cases were confined tot he uterine corpus (FIGO stage IB). Within a mean follow up of 16.7 mo. (2 – 45 mo) 5/6 most women are alive. But the prognostic data should be interpreted with care, because of limited number of cases and short follow up time. The pathogenesis of ML-AC of the endometrium is unclear. Recent molecular data have reported that ML-AC are characterised by KRAS-mutation, gain of 1q, lack of PTEN-mutation, gain of chromosomes 10 and 12 as well as PIK3CA-mutations. Interestingly, the reported KRAS mutation for ovarian ML-AC were G12D, whereas all endometrial ML-AC were G12V. Abstracting available data on histopathology, immunophenotype and molecular level, endometrial ML-AC are likely of Müllerian origin with mesonephric differentiation.