Mesonephric-like Adenocarcinoma of the Uterine Corpus: Comprehensive Analyses of Clinicopathological, Molecular, and Prognostic Characteristics With Retrospective Review of 237 Endometrial Carcinoma Cases

Abstract

Background/Aim: Uterine mesonephric-like adenocarcinoma (MLA) is a rare malignant tumor of the female genital tract. Patients and Methods: We reviewed 237 endometrial carcinoma cases and investigated the clinicopathological and molecular characteristics of uterine MLA. Results: We found that 3.0% (7/237) of the endometrial carcinoma cases were MLAs. Compared to endometrial endometrioid carcinoma, MLA showed larger tumor size, deeper myometrial invasion, increasingly advanced-stage disease, and more frequent lymphovascular space invasion. All MLAs exhibited architectural diversity, compactly aggregated small tubules, eosinophilic intraluminal secretions, overlapped and angulated nuclei, scant cytoplasm, and presence of spindle cells. All the MLAs expressed at least two mesonephric markers. All except one MLA harbored activating Kirsten rat sarcoma viral oncogene homolog mutations. All patients with MLA developed postoperative metastases. MLA had the lowest progression-free survival rate among different histological types of endometrial carcinoma. Conclusion: Uterine MLA is a highly aggressive gynecological malignancy, showing unique morphological and molecular features, frequent recurrences and metastases, as well as poor prognosis.Mesonephric adenocarcinoma (MA) is a rare malignant tumor of the female genital tract. It is thought to originate from the mesonephric remnants (1-3), which are usually located in the lateral wall of the vagina and uterine cervix, the broad ligament, and the ovarian hilum (4, 5). The term mesonephric-like adenocarcinoma (MLA) has been suggested for a malignant tumor arising in the uterine corpus and the adnexa. MLA shows similar histological, immunophenotypical, and genetic features to those of cervical MA (1,(6)(7)(8)(9)(10)(11)(12). It is morphologically characterized by various architectural patterns, such as tubular, ductal, papillary, spindle, solid, trabecular, retiform, and sex cord-like (1,6,8,9). Diverse growth patterns make it difficult 526

Mesonephric-like Carcinosarcoma of the Uterine Corpus: Clinicopathological, Molecular and Prognostic Characteristics in Comparison With Uterine Mesonephric-like Adenocarcinoma and Conventional Endometrial Carcinosarcoma

“…FFPE tissue blocks were sectioned at 4 μm on a standard rotary microtome, and sections were placed in a water bath on microscopic glass slides. Expression of p53 protein was assessed by immunohistochemistry using a BOND-MAX automated immunostainer (Leica Biosystems, Buffalo Grove, IL, USA) (6,8,9,12,17,(33)(34)(35)(36)(37). After antigen retrieval, the sections were incubated with anti-p53 antibody (dilution 1:200, clone DO-7, catalog number NCL-L-p53-DO7, Leica Biosystems).…”

“…Mesonephric-like adenocarcinoma (MLA) of the uterine corpus is a rare but distinct gynecological malignancy that morphologically resembles mesonephric adenocarcinoma of the uterine cervix or vagina, which originates from mesonephric remnants (6)(7)(8)(9)(10)(11)(12)(13)(14). Uterine MLA was introduced as a new histological type in both the endometrium and ovary in the recent 2020 World Health Organization (WHO) classification of female genital tumors (15,16).…”

Clinicopathological and Prognostic Significance of Programmed Death Ligand-1 SP142 Expression in 132 Patients With Triple-negative Breast Cancer

“…The 4-μm slices from FFPE blocks were subjected to a series of processes including deparaffinization, dehydration with xylene, and rehydration in a graded series of alcohol solutions. Immunostaining was performed using an automatic immunostainer and a compact polymer method (Bond Intense Detection Kit, Leica Biosystems, Newcastle upon Tyne, UK) (1,21,(23)(24)(25)(26)(27). We used a rabbit recombinant monoclonal PD-L1 antibody (clone SP142, prediluted, Ventana Medical Systems) as the primary antibody.…”

Cytological features of mesonephric‐like adenocarcinoma of the uterine corpus

“…[16][17][18][19] However, accurate diagnosis of uterine MLA is critical because of its aggressive behavior and poor prognosis. [5][6][7][8][9] Immunostaining using a panel of antibodies can aid the pathologist in making an accurate diagnosis. Even in cases with pulmonary and hepatic metastases, due to transcription termination factor 1 (TTF1) positivity in most MLAs, a combination of multiple mesonephric markers, including TTF1, CD10, paired box 2 (PAX2), and GATA-binding protein 3 (GATA3), 8,9,12 can help prevent misdiagnosis as hepatic metastasis of TTF1-positive pulmonary adenocarcinoma.…”

“…[8][9][10][11][12] Histologically, MLA exhibits various growth patterns, such as tubular, ductal, papillary, solid, sex cord-like, retiform, and glomeruloid architecture. 8,9,[12][13][14][15][16] The growth diversity and resemblance of uterine MLA to more common histological types of endometrial carcinoma, including endometrioid and serous carcinomas, 8,9,12 hinders its distinction from other endometrial carcinoma types. [16][17][18][19] However, accurate diagnosis of uterine MLA is critical because of its aggressive behavior and poor prognosis.…”