Cytologic features of upper gynecologic tract adenocarcinomas exhibiting mesonephric‐like differentiation

Abstract

Background Mesonephric adenocarcinomas are rare neoplasms which most commonly arise in the lateral cervix and vagina. Tumors with similar morphologic, immunophenotypic, and molecular characteristics recently have been described in the uterine corpus and ovary. Herein, the authors sought to characterize the cytomorphologic features of adenocarcinomas exhibiting mesonephric‐like differentiation arising in the upper gynecologic tract. Methods Institutional databases were queried retrospectively for tumors of the upper gynecologic tract described as a “tumor of Wolffian origin” or “with mesonephric features” between 2007 and 2017. All available cytologic material was reviewed. Cytomorphologic characteristics were evaluated by 3 pathologists. Results The current study cohort consisted of 8 cases taken from 7 patients. Primary sites included the ovary (3 cases); endometrium (4 cases); and pelvis, not otherwise specified (1 case). All cases demonstrated tight 3‐dimensional clusters of overlapping cells. Additional architectural features included tubular (5 of 8 cases; 63%) and papillary (3 of 8 cases; 38%) formations. Cells were small with scant (7 of 8 cases; 88%) to moderate (1 of 8 cases; 12%) cytoplasm. Three of the 8 cases (38%) demonstrated extracellular hyaline globules. Nuclei were uniform in size (6 of 8 cases; 75%) or showed mild anisonucleosis (2 of 8 cases; 25%). Nuclear grooves and indentations were observed in all cases. Mitoses (5 of 8 cases; 63%) and apoptotic bodies (4 of 8 cases; 50%), when present, were rare. No necrosis was noted. Conclusions Adenocarcinomas exhibiting mesonephric‐like differentiation show a monotonous population of small cells with scant to moderate cytoplasm and abundant nuclear grooves arranged in tight, overlapping, 3‐dimensional clusters. Occasionally, papillary or tubular architecture, as well as extracellular hyaline globules, may be seen. These features should prompt further testing (eg, immunohistochemistry) to confirm the diagnosis and to exclude potential mimics.

Cytological features of cervical well-differentiated mesonephric adenocarcinoma: Report a case with immunohistochemical findings

“…Additionally, papillary, glandular and tubulopapillary patterns have been reported in cytology of ML-CA [5]. Cord-like, solid, spindled, hobnail, glomeruloid, and retiform patterns have been described in histologic findings [5][6]. In our case, a few tubules with "mild" appearance and some indivivual atypical cells accompanied with some normal endocervical cells confused pathologists.…”

“…Three architectures such as ductal, tubular and sheet-like variants have been characterized in cytology of cervical MA [2]. Additionally, papillary, glandular and tubulopapillary patterns have been reported in cytology of ML-CA [5]. Cord-like, solid, spindled, hobnail, glomeruloid, and retiform patterns have been described in histologic findings [5][6].…”

Mesonephric-like adenocarcinoma of the ovary

“…Mesonephric adenocarcinoma (MNAC) of the female genital tract is an infrequent non–human papilloma virus-related neoplasm, which is considered to originate from the embryonal remnant of mesonephric duct (also known as Wolffian duct). [ 1 , 2 ] MNAC most commonly occur in the lower human female genital tract, particularly in lateral cervix and vagina, while MNAC in the upper female genital tract is very rare, especially in ovary. [ 1 ] Mesonephric adenocarcinomas have only rarely been reported to arise in the uterine corpus, but never been reported in the ovary.…”

“…[ 1 , 2 ] MNAC most commonly occur in the lower human female genital tract, particularly in lateral cervix and vagina, while MNAC in the upper female genital tract is very rare, especially in ovary. [ 1 ] Mesonephric adenocarcinomas have only rarely been reported to arise in the uterine corpus, but never been reported in the ovary. It was reported that adenocarcinomas of endometrium and ovary shared morphologic, immuonphenotypic, and molecular features with mesonephric adenocarcinoma, but were lack of association with mesonepheric remnants or hyperplasia.…”

“…It was reported that adenocarcinomas of endometrium and ovary shared morphologic, immuonphenotypic, and molecular features with mesonephric adenocarcinoma, but were lack of association with mesonepheric remnants or hyperplasia. [ 1 , 3 ] Hence, mesonephric-like adenocarcinomas (MLAs) are recently suggested to describe these neoplasms that occur in uterine corpus and ovary. Due to the rareness of the disease, there are only six case reports including ten cases of ovarian MLA in the English literature up to now.…”