Mesonephric adenocarcinoma with a sarcomatous component, a notable subtype of cervical carcinosarcoma: a case report and review of the literature

Abstract

Carcinosarcoma of the uterine cervix is less common than its counterpart in the uterine corpus. On the other hand, mesonephric adenocarcinoma is also a rare neoplasm in the uterine cervix, and it has been reported that mesonephric adenocarcinomas are often accompanied by sarcomatous components. We present a case of mesonephric adenocarcinoma with a sarcomatous component which arose in a 63-year-old postmenopausal woman. The hysterectomy specimen grossly showed an exophytic mass measuring 1.8 cm in the uterine cervix. Histologically, diffuse mesonephric hyperplasia and adenocarcinoma with malignant spindle cell proliferation was recognized, and therefore the tumor was diagnosed as “mesonephric adenocarcinoma with a sarcomatous component.” The review of the literature of cervical carcinosarcoma and cervical mesonephric adenocarcinoma revealed that 16% of cervical carcinosarcoma is of mesonephric duct origin, and that mesonephric adenocarcinoma seems to be more likely to have sarcomatous change. We think the presence of a sarcomatous component in the cervical biopsy specimen could be helpful in the diagnosis of mesonephric duct origin.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1243996503911062

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

“…In fact, many of the carcinoma cases reported in the literature have been shown to have an accompanying benign component intimately associated with the malignant glands (4, 6, 12, 14). Compared to their benign precursors, the malignant counterparts display more pronounced cytologic atypia and increased mitotic activity, an infiltrative growth pattern, and back-to-back or complex architectural arrangements, and may have a stromal response.…”

Mesonephric Carcinosarcoma Involving Uterine Cervix and Vagina

“…Mesonephric carcinoma is an unusual tumor, rarely reported, originating in mesonephric remnants, caused by incomplete involution of the Wolffian (mesonephric) duct (1)(2)(3)(4)(5). These remnants can evolve into hyperplastic areas and even progress to carcinoma.…”

“…Over 40 such cases have been reported, including 4 large series with 8 to 11 cases each (2)(3)(4)(5) as well as occasional case reports. However, a sarcomatous component was reported in less than a dozen cases (1)(2)(3)(4)(5). Although the tumor has classic morphologic features, some cases can mimic Mu¨ller-ian adenocarcinoma and be misdiagnosed, especially those with significant ductal pattern.…”

Mesonephric Adenocarcinoma of Endocervix With Lobular Mesonephric Hyperplasia: Case Report

“…Th e presence of sarcomatous components is the key to carcinosarcoma diagnosis 8 . Only 16% of carcinosarcomas reported in the English literature were of mesonephric duct origin 2 . Th e typical histologic features of clear-cell cytoplasm and hobnail cell pattern, and the presence of PAS positive intraluminal secretion with PAS positive intracytoplasmic globules direct us to the diagnosis of clear-cell carcinoma 9 .…”

“…Th ey are usually located in the uterine cervix, lateral wall of the vagina, broad ligament, mesosalpinx and in the ovarian hilium 1 . Mesonephric duct remnants are found in 10%-22% of adult uterine cervices 2,3 . Hyperplasia of these remnants is a benign lesion that is almost always discovered incidentally in cone biopsy or hysterectomy specimens 1,4 .…”