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https://doi.org/10.20471/acc.2016.55.02.22

Mesonephric adenocarcinoma of endocervix with lobular mesonephric hyperplasia: case report

Mario Puljiz ; Department of Gynecologic Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Damir Danolić ; Department of Gynecologic Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Lucija Kostić ; Department of Gynecologic Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ilija Alvir ; Department of Gynecologic Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Darko Tomica ; Department of Gynecologic Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivica Mamić ; Department of Gynecologic Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivana Vlastelica Munivrana ; Department of Anesthesiology and Intensive Care, Šibenik General Hospital, Šibenik, Croatia
Marko Puljiz ; School of Medicine, University of Split, Split, Croatia
Danko Velimir Vrdoljak ; Department of Surgical Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Melita Perić Balja ; Department of Clinical Pathology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia

Abstract

Mesonephric adenocarcinoma is a rare variant of cervical adenocarcinoma. We present a case of mesonephric adenocarcinoma of endocervix with cervical and vaginal lobular mesonephric hyperplasia in a 57-year-old woman. Vaginal bleeding persisting for 12 months was the only symptom. Histopathologic findings and characteristic immunophenotype are crucial for the diagnosis. The tumor was composed of papillary formation with a central fibrovascular stroma, villoglandular and densely compact tubular structures containing intraluminal eosinophilic secretion, and coated with one or more rows of cylindrical atypical epithelial cells. There were 30 pathologic mitotic shapes found per 10 HPF. Th e tumor invaded nearly full-thickness of cervical stroma with positive lymphovascular space invasion and clear margins. The case demonstrated characteristic cytokeratin 7, vimentin and
epithelial membrane antigen positivity and high Ki-67 proliferation index (60%). Estrogen receptors, progesterone receptors and carcinoembryonic antigen were negative. Intratubular lumen secretion was periodic acid-Schiff positive with periodic acid-Schiff negative carcinoma cells. Differential diagnoses include adenoma malignum, well-differentiated villoglandular adenocarcinoma, endometrioid adenocarcinoma, serous adenocarcinoma, mesonephric adenocarcinoma with a sarcomatous component, clear-cell carcinoma and mesonephric hyperplasia. Radical hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy was performed. Three years after the surgery, the patient remains well. There has not been any evidence of local or distant recurrence. There are no specific recommendations for the treatment of this rare disease. It remains uncertain whether surgical approach is sufficient or the treatment should include additional radio/chemotherapy.

Keywords

Uterine cervical neoplasms – surgery; Adenocarcinoma – surgery; Mesonephroma – pathology; Hyperplasia; Cytodiagnosis; Vagina – pathology

Hrčak ID:

164886

URI

https://hrcak.srce.hr/164886

Publication date:

1.6.2016.

Article data in other languages: croatian

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