Cervical Mesonephric Adenocarcinoma: A Case Report of a Rare Gynecological Tumor from Embryological Remains of the Female Genital Tract

Abstract

Introduction Malignant mesonephric tumors are uncommon in the female genital tract, and they are usually located where embryonic remnants of Wolffian ducts are detected, such as the uterine cervix. The information about these tumors, their treatment protocol, and prognosis are scarce.

Case report A 60-year-old woman with postmenopausal vaginal bleeding was initially diagnosed with endometrial carcinoma. After suspicion co-testing, the patient underwent a loop electrosurgical excision of the cervix and was eventually diagnosed with mesonephric adenocarcinoma. She was subjected to a radical hysterectomy, which revealed International Federation of Gynecology and Obstetrics (FIGO) IB1 stage, and adjuvant radiotherapy. The follow-up showed no evidence of recurrence after 60 months.

Conclusion We present the case of a woman with cervical mesonephric adenocarcinoma. When compared with the literature, this case had the longest clinical follow-up without evidence of recurrence, which reinforces the concept that these tumors are associated with a favorable prognosis if managed according to the guidelines defined for the treatment of patients with cervical adenocarcinomas. Though a rare entity, it should be kept in mind as a differential diagnosis for other cervical cancers.

Keywords

cervix - embryonic remnants - neoplasia

Publication History

Received: 29 April 2020

Accepted: 15 December 2020

Article published online:
30 March 2021

• References

• 1 Howitt BE, Nucci MR. Mesonephric proliferations of the female genital tract. Pathology 2018; 50 (02) 141-150 DOI: 10.1016/j.pathol.2017.11.084.
• 2 Ferry JA, Scully RE. Mesonephric remnants, hyperplasia, and neoplasia in the uterine cervix. A study of 49 cases. Am J Surg Pathol 1990; 14 (12) 1100-1111 DOI: 10.1097/00000478-199012000-00002.
• 3 Wu H, Zhang L, Cao W, Hu Y, Liu Y. Mesonephric adenocarcinoma of the uterine corpus. Int J Clin Exp Pathol 2014; 7 (10) 7012-7019
• 4 Meguro S, Yasuda M, Shimizu M, Kurosaki A, Fujiwara K. Mesonephric adenocarcinoma with a sarcomatous component, a notable subtype of cervical carcinosarcoma: a case report and review of the literature. Diagn Pathol 2013; 8: 74 DOI: 10.1186/1746-1596-8-74.
• 5 Park KJ, Kiyokawa T, Soslow RA, Lamb CA, Oliva E, Zivanovic O. et al. Unusual endocervical adenocarcinomas: an immunohistochemical analysis with molecular detection of human papillomavirus. Am J Surg Pathol 2011; 35 (05) 633-646 DOI: 10.1097/PAS.0b013e31821534b9.
• 6 Bifulco G, Mandato VD, Mignogna C, Giampaolino P, Sardo AS, De Cecio R. et al. A case of mesonephric adenocarcinoma of the vagina with a 1-year follow-up. Int J Gynecol Cancer 2008; 18 (05) 1127-1131 DOI: 10.1111/j.1525-1438.2007.01143.x.
• 7 Yap OWS, Hendrickson MR, Teng NNH, Kapp DS. Mesonephric adenocarcinoma of the cervix: a case report and review of the literature. Gynecol Oncol 2006; 103 (03) 1155-1158 DOI: 10.1016/j.gore.2016.05.002.
• 8 Silver SA, Devouassoux-Shisheboran M, Mezzetti TP, Tavassoli FA. Mesonephric adenocarcinomas of the uterine cervix: a study of 11 cases with immunohistochemical findings. Am J Surg Pathol 2001; 25 (03) 379-387 DOI: 10.1097/00000478-200103000-00013.
• 9 Pirog EC, Kleter B, Olgac S, Bobkiewicz P, Lindeman J, Quint WG. et al. Prevalence of human papillomavirus DNA in different histological subtypes of cervical adenocarcinoma. Am J Pathol 2000; 157 (04) 1055-1062 DOI: 10.1016/S0002-9440(10)64619-6.
• 10 Cavalcanti MS, Schultheis AM, Ho C, Wang L, DeLair DF, Weigelt B. et al. Mixed mesonephric adenocarcinoma and high-grade neuroendocrine carcinoma of the uterine cervix: case description of a previously unreported entity with insights into its molecular pathogenesis. Int J Gynecol Pathol 2017; 36 (01) 76-89 DOI: 10.1097/PGP.0000000000000306.
• 11 Dierickx A, Göker M, Braems G, Tummers P, Van den Broecke R. Mesonephric adenocarcinoma of the cervix: Case report and literature review. Gynecol Oncol Rep 2016; 17: 7-11 DOI: 10.1016/j.gore.2016.05.002.
• 12 Montalvo N, Redrobán L, Galarza D. Mesonephric adenocarcinoma of the cervix: a case report with a three-year follow-up, lung metastases, and next-generation sequencing analysis. Diagn Pathol 2019; 14 (01) 71 DOI: 10.1186/s13000-019-0847-8.
• 13 Zhang L, Cai Z, Ambelil M, Conyers J, Zhu H. Mesonephric adenocarcinoma of the uterine corpus: report of 2 cases and review of the literature. Int J Gynecol Pathol 2019; 38 (03) 224-229 DOI: 10.1097/PGP.0000000000000493.
• 14 Mirkovic J, Dong F, Sholl LM, Garcia E, Lindeman N, MacConaill L. et al. Targeted Genomic Profiling of Female Adnexal Tumors of Probable Wolffian Origin (FATWO). Int J Gynecol Pathol 2019; 38 (06) 543-551 DOI: 10.1097/PGP.0000000000000545.
• 15 Yamamoto Y, Akagi A, Izumi K, Kishi Y. Carcinosarcoma of the uterine body of mesonephric origin. Pathol Int 1995; 45 (04) 303-309 DOI: 10.1111/j.1440-1827.1995.tb03461.x.
• 16 Ribeiro B, Silva R, Dias R, Patrício V. Carcinosarcoma of the uterine cervix: a rare pathological finding originating from mesonephric remnants. BMJ Case Rep 2019; 12 (03) e227050 DOI: 10.1136/bcr-2018-227050.
• 17 Chapel DB, Joseph NM, Krausz T, Lastra RR. An ovarian adenocarcinoma with combined low-grade serous and mesonephric morphologies suggests a müllerian origin for some mesonephric carcinomas. Int J Gynecol Pathol 2018; 37 (05) 448-459 DOI: 10.1097/PGP.0000000000000444.
• 18 Howitt BE, Emori MM, Drapkin R, Gaspar C, Barletta JA, Nucci MR. et al. GATA3 is a sensitive and specific marker of benign and malignant mesonephric lesions in the lower female genital tract. Am J Surg Pathol 2015; 39 (10) 1411-1419 DOI: 10.1097/PAS.0000000000000471.
• 19 Lee S, Rose MS, Sahasrabuddhe VV, Zhao R, Duggan MA. Tissue-based immunohistochemical biomarker accuracy in the diagnosis of malignant glandular lesions of the uterine cervix: a systematic review of the literature and meta-analysis. Int J Gynecol Pathol 2017; 36 (04) 310-322 DOI: 10.1097/PGP.0000000000000345.