Malignant Mesonephric Tumors of the Female Genital Tract

Abstract

Nine malignant mesonephric tumors were obtained from the consultation files of one of the authors (J.P.) over a 13-year period (1988-2001). There were 4 adenocarcinomas (ACs) and 5 malignant mixed mesonephric tumors (MMMTs). The ACs were found in the cervix (3) and vagina (1). The MMMTs involved the uterus (1), cervix (3), and vagina (1). Most patients presented with abnormal vaginal bleeding. The 4 patients with mesonephric AC ranged in age from 24 to 54 years (mean, 41 years). The tumors measured 2 to 6 cm (mean, 3.7 cm). Two ACs were stage I and two were stage II. Two of the three patients with follow-up information were alive without clinical evidence of disease at 3 and 11.5 years, and the other was alive with recurrent tumor 8.5 years postoperatively. The 5 patients with MMMTs ranged in age from 37 to 62 years (mean, 49 years). The mean size of four tumors was 5.2 cm (range, 3.5-8 cm). The uterine MMMT infiltrated the entire myometrial wall extending to the endometrial cavity where it resembled an endometrial polyp. Although the most common histologic pattern in the current series was the glandular (ductal) pattern, retiform, tubular, and solid growth patterns were also encountered. Among the MMMT subgroup, the sarcomatous component was homologous in 3 cases (endometrial stromal or spindle cell) and heterologous in the other 2 cases (skeletal muscle and cartilage). Of the 4 patients with follow-up information available, 1 (stage II) died of disease 7 months after surgery, another (stage IV) was alive with bone metastases at 3.3 years, and the other 2 patients (stages IB and IC) had no clinical evidence of disease at 1 and 3.7 years, respectively. Evidence of mesonephric hyperplasia was found in 5 (42%) cases. The MMMT that arose in the corpus presented as an endometrial polyp. In this case, histologic differential diagnosis includes serous carcinoma, endometrial stromal sarcoma, and uterine tumor resembling ovarian sex cord-stromal tumor. Immunostainings are not helpful. Mesonephric ACs often present in early stage and have better prognosis than their müllerian counterparts. Surgery alone appears to be the treatment of choice. In contrast, MMMTs may present in advanced stage and are aggressive tumors, similar to malignant mixed müllerian tumors.

Targeted genomic profiling reveals recurrent KRAS mutations and gain of chromosome 1q in mesonephric carcinomas of the female genital tract

“…6 Our study found no correlation between the molecular features of mesonephric carcinoma and presence of a spindled/solid component, but this could potentially be attributed to the fact that most of the cases had only one slide of tumor available for review, which may have not been representative of the overall morphological appearances of the neoplasm.…”

“…1-3 Primary mesonephric carcinomas of the uterine corpus and the vagina have also been described. [4][5][6][7][8] Patients with mesonephric carcinoma usually present with abnormal vaginal bleeding (in~60-70% of the cases), abnormal Papanicolaou smear, a cervical mass on pelvic examination, or the tumor can be discovered incidentally. 1,2 Grossly, these tumors are frequently in the form of an exophytic, nodular, or polypoid friable mass usually in the lateral wall of the cervix or involving the cervical wall circumferentially.…”

Mesonephric adenocarcinoma of the uterine corpus with intracystic growth completely confined to the myometrium: a case report and literature review

“…These authors proposed that corpus MA originated from Müllerian tissue and obtained the morphological and immunohistochemical phenotype characteristic of mesonephric differentiation; this tumor is described as a 'mesonephric-like adenocarcinoma' rather than MA. In addition to that case, 10 additional cases of corpus MA, including the present tumor, have been reported [2][3][4][5][6][7][8]10]. While one case was believed to be derived from the endometrium, the epicenter of five tumors was in the myometrial layer [5,6,8,10], and three tumors were completely confined to the myometrial layer [2,3] (Table 2).…”

“…A leiomyoma nodule is observed immediately to the left [12]. Few cases of MA have been reported in the uterine corpus [2][3][4][5][6][7][8][9][10]. A unique histologic pattern of uniform small tubules containing intraluminal hyaline material is reminiscent of mesonephric remnants [13].…”

“…MA is believed to arise from benign mesonephric remnants or hyperplasia located in the lateral walls of the uterine cervix [1]. MA is exceptionally rare in the uterine corpus; only 16 cases have been reported [2][3][4][5][6][7][8][9][10]. Here we present a case of MA with a unique growth pattern within the myometrial layer of the uterine corpus and provide a review of published cases.…”