Four cases of mesonephric adenocarcinoma of the cervix: a rare histology

Abstract

Introduction: Mesonephric adenocarcinoma of the uterine cervix is a rare tumor, originating from remnants of the mesonephric duct. The differential diagnosis from other cervical carcinoma can be challenging. The existing data in the literature, regarding clinical history, diagnosis, prognosis and treatment is scarce.
Methods: Four patients diagnosed with mesonephric adenocarcinoma of the cervix were treated at our institution. The clinicopathological data of these patients was collected.
Results: The patients presented postmenopausal metrorrhagia at diagnosis. Three patients underwent type C radical hysterectomy and pelvic lymphadenectomy, being staged (FIGO) as pIB1, pIB3 and pIIB, respectively. One patient was under surveillance, one patient underwent adjuvant treatment (radiotherapy and brachytherapy) and the third patient was restaged, stage IV, initiating palliative chemotherapy. One patient, stage IIIC1, underwent radical radiochemotherapy and brachytherapy. The patient presented regional and distant recurrence, and it was decided systemic treatment. Histologically, the tumors presented a mixture of patterns including papillary, glandular with the presence of spindle cells in two patients. The immunohistochemistry showed expression of CAM 5.2, CD10, vimentin, GATA3, calretinin, absence of expression of WT1 and hormone receptors, and p53 wild-type.
Conclusions: The rarity of this disease raises challenges in its management, namely diagnosis, prognosis and therapeutic approach.