Mesonephric Carcinosarcoma Involving Uterine Cervix and Vagina

Abstract

Mesonephric carcinomas are rare tumors predominantly arising in the uterine cervix from mesonephric remnants. Although the tumor has classic morphologic features, some cases can mimic Müllerian adenocarcinoma and be misdiagnosed, especially those with significant ductal pattern. Moreover, there is an overlap in immunohistochemical results with endometrial and endocervical carcinomas. In this study, we report 2 cases of mesonephric carcinosarcoma, originally diagnosed as Müllerian carcinomas, 1 presenting in the vagina; review immunohistochemical results including positivity for GATA-3, not previously reported and comment on the proposed panel of PAX8, p16, and estrogen receptors as discriminators of Müllerian adenocarcinoma (endocervical or endometrial) versus mesonephric carcinoma.

Mesonephric adenocarcinoma of the cervix: a case report with a three-year follow-up, lung metastases, and next-generation sequencing analysis

“…It accounts for less than 1% of all tumors at this site and is not related to human papillomavirus (HPV). It is usually located deep in the lateral cervical stroma, but rare cases of primary vaginal and uterine corpus MNAC have been reported [13, 14]. The average age of presentation is 53 years, and there is no apparent peak, since its prevalence in age groups from the third through the sixth decade is similar, with 26% of patients being younger than 40 years.…”

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

“…When pure, adenocarcinomas may exhibit a variety of patterns even within the same tumor, previously described as tubular, ductal, retiform, sex-cord-like, and solid (4). Twelve cases associated with a sarcomatoid component have been described (4–7, 14, 15), three of which exhibited heterologous differentiation in the form of osteosarcoma, rhabdomyosarcoma, and chondrosarcoma (4, 5). Like many of the more unusual types of cervical adenocarcinomas, they are HPV-negative (2, 16).…”

“…This must be kept in mind, because it is traditionally thought of as positive in this scenario (88% of cases positive in the two largest series) (14, 16). More recently, GATA-3 immunoexpression has been demonstrated in benign and malignant mesonephric proliferations, and may be a helpful marker in the appropriate setting (7, 18, 19). Conversely, TTF-1 and HNF1-beta positivity has been identified in a proportion of mesonephric adenocarcinomas, and may be misleading (16).…”

“…These tumors arise from mesonephric remnants and hyperplasia, embryonic vestiges of the mesonephric (or Wolffian) duct in the female genital tract and their benign proliferative counterpart, respectively. These tumors are characterized by a wide morphologic array and have been reported to occasionally harbor a sarcomatoid component (carcinosarcoma or mixed malignant mesonephric tumor) (4–7). However, other forms of dedifferentiation have not been described to date.…”

Mesonephric adenocarcinoma of the vagina

“…A few more reports on MA occurring in the cervix, uterus, and urinary bladder, including pediatric patients, have been published [1–3, 6, 7, 14, 16]. …”