Case ReportMesonephric adenocarcinoma of the cervix: A case report and review of the literature
Introduction
Malignant mesonephric tumors are rare neoplasms derived from remnants of the paired mesonephric (Wolffian) ducts. Little is known regarding optimal therapy or prognosis of mesonephric adenocarcinoma of the cervix, with some suggesting an indolent course with a propensity for multiple recurrences [1], [2], and others an associated aggressive clinical course [3]. Of the 30 well-documented cases of mesonephric tumors of the cervix, clinical outcomes are available for 26 patients [1], [2], [3], [4], [5], [6], [7], [8], [9].
In this report, we describe a patient with mesonephric adenocarcinoma arising in the uterine cervix in whom longer term clinical follow-up was available. A review of the previous cases of malignant mesonephric tumors of the uterine cervix is also presented.
Section snippets
Case report
A 54-year-old Caucasian woman presented with a 4-month history of postmenopausal vaginal bleeding. Physical examination revealed a normal-sized uterus with a friable endocervical polyp. A cervical polypectomy and an endometrial biopsy were performed. Initial pathologic evaluation showed the presence of high grade endometrioid adenocarcinoma in both the endocervical and endometrial specimens. A transvaginal ultrasound described an 8.8 × 4.4 × 3.5 cm uterus with a 7.6-mm endometrial stripe and a
Discussion
Vestigial remnants of the mesonephric ducts are identified in up to 22% of adult cervices [1], [10]. They are not uncommonly encountered deep in the lateral walls of the cervix where they give rise to hyperplasia and, rarely, malignant mesonephric tumors. Table 1 summarizes the 30 cases of malignant mesonephric carcinomas of the cervix thus far reported in the literature. Our patient displayed similarities with the previously reported cases in terms of age and symptoms at presentation and early
References (13)
- et al.
Mesonephric carcinoma of the cervix-differentiation from endocervical adenocarcinoma
Am. J. Obstet. Gynecol.
(1962) - et al.
Cervical adenocarcinoma arising in florid mesonephric hyperplasia: report of a case with immunocytochemical studies
Gynecol. Oncol.
(1987) Adenocarcinoma of the uterine cervix of probable wolffian origin
Pathology
(1979)- et al.
Mesonephric remnant hyperplasia of the cervix: a clinicopathologic analysis of 14 cases
Gynecol. Oncol.
(1993) - et al.
A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with Stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group Study
Gynecol. Oncol.
(1999) - et al.
Mesonephric remnants, hyperplasia, and neoplasia in the uterine cervix. A study of 49 cases
Am. J. Surg. Pathol.
(1990)
Cited by (19)
Mesonephric adenocarcinoma of the cervix: Case report and literature review
2016, Gynecologic Oncology ReportsCitation Excerpt :In this literature review 23% of the reported mesonephric carcinomas were associated with a spindled cell component (malignant mixed mesonephric tumor, MMMT). This is a biphasic variant of a mesonephric carcinoma with sarcomatoid features (Clement et al., 1995; Yap et al., 2006). The typical background lesion of a mesonephric carcinoma is florid mesonephric hyperplasia, characterized by a densely eosinophilic luminal secretion (Menon et al., 2013).
Neoplastic Lesions of the Cervix
2011, Surgical Pathology ClinicsCitation Excerpt :Due to the rarity of the tumor, little is known regarding optimal therapy or prognosis. In a review article looking at all published reported cases, local recurrence and distant metastasis were commonly found, including to bone, lung, pleura, abdomen and liver.187 Median and mean times to recurrence were 2.1 and 3.6 years, respectively, and most patients with recurrence died within 1 year, despite therapy.
Diverse facets of cervical adenocarcinoma: Comprehensive review of clinicopathologic features and diagnostic criteria
2010, Diagnostic HistopathologyCitation Excerpt :Papillary proliferations in mesonephric ADC may mimic serous or clear cell adenocarcinoma, however in contrast to these tumours papillary mesonephric adenocarcinoma shows low nuclear grade. Clinical outcome was reported for 31 patients (reviewed by Yap et al.54). Eighty two percent of patients presented with Stage IB tumours and 18% with Stage II–IV tumours.
Female reproductive system
2010, Differential Diagnosis in Surgical PathologyFemale reproductive system
2009, Differential Diagnosis in Surgical Pathology: Expert Consult - Online and PrintMesonephric adenocarcinoma of the uterine cervix: A case report with immunohistochemical and ultrastructural studies
2008, Pathology Research and Practice