Indian Journal of Pathology and Microbiology

: 2013  |  Volume : 56  |  Issue : 1  |  Page : 51--53

Mesonephric adenocarcinoma (endometrioid type) of endocervix with diffuse mesonephric hyperplasia involving cervical wall and myometrium: An unusual case report

Santosh Menon1, Komal Kathuria1, Kedar Deodhar1, Rajendra Kerkar2,  
1 Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
2 Department of Gynecologic Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India

Correspondence Address:
Santosh Menon
Department of Pathology, 8th Floor, Annexe Building, Tata Memorial Hospital, Dr. Ernest Borges Marg, Parel, Mumbai, Maharashtra


Malignant mesonephric tumors are rare variants of cervical adenocarcinoma, derived from remnants of mesonephric ducts and are associated with mesonephric remnants and/or mesonephric hyperplasia. Few cases have been described in literature. We report an unusual case of cervical mesonephric adenocarcinoma of endometrioid type with squamous morules in association with diffuse mesonephric hyperplasia involving the cervical walls and extending into the myometrium.

How to cite this article:
Menon S, Kathuria K, Deodhar K, Kerkar R. Mesonephric adenocarcinoma (endometrioid type) of endocervix with diffuse mesonephric hyperplasia involving cervical wall and myometrium: An unusual case report.Indian J Pathol Microbiol 2013;56:51-53

How to cite this URL:
Menon S, Kathuria K, Deodhar K, Kerkar R. Mesonephric adenocarcinoma (endometrioid type) of endocervix with diffuse mesonephric hyperplasia involving cervical wall and myometrium: An unusual case report. Indian J Pathol Microbiol [serial online] 2013 [cited 2021 Oct 27 ];56:51-53
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Mesonephric duct remnants are found in - 1-22% of adult uterine cervices, mostly in the lateral walls. [1],[2] However, hyperplasia of these remnants is rare and adenocarcinomas arising from these are even rarer. Mesonephric hyperplasia is further classified as lobular mesonephric hyperplasia, diffuse mesonephric hyperplasia, and mesonephric ductal hyperplasia. [2] These categories have no clinical significance, but awareness of their features among pathologists is important to prevent their potential misdiagnosis as in situ or invasive adenocarcinoma. Mesonephric adenocarcinomas are even rarer and arise in the vicinity of mesonephric duct remnants in most cases. They may morphologically be misdiagnosed as other varieties of adenocarcinomas and immunohistochemical evaluation may be necessary to delineate these tumors. [3] These tumors are likely to have a more aggressive clinical course. [3],[4]

 Case Report

A 65-year-old female presented with post-menopausal bleeding of 6 months duration. On per vaginal examination, the patient had third-degree uterine prolapse and the cervix was hard with a 3 × 3 cm cervical mass. Bilateral parametria were free. On magnetic resonance imaging (MRI), a mass measuring 3.4 × 2.8 × 2.1 cm was seen protruding through the vaginal introitus, associated with third-degree uterine prolapse and cystocoele. Radiologically, endometrium, myometrium, and bilateral parametria were unremarkable. In addition, bilateral multiloculated cystic adnexal masses were identified, the left measuring 6.4 × 4.5 × 4.1 cm and the right measuring 6.5 × 5.8 × 4.5 cm. There was no significant lymphadenopathy.

Biopsy from the cervical mass revealed an adenocarcinoma with squamous morules and was reported as endometrioid adenocarcinoma, International Federation of Gynecology and Obstetrics (FIGO) grade I. The patient underwent a hysterectomy with bilateral salphigo-oopherectomy and pelvic lymph node dissection. On microscopy, the cervical mass was confirmed to be an adenocarcinoma with tubulo-glandular pattern and conspicuous squamous morules resembling an endometrioid adenocarcinoma. The cervical stroma just adjacent to the tumor revealed diffuse proliferation of mesonephric remnants in the form of small glands and tubules. These hyperplastic mesonephric tubules were seen extending into the myometrium; however, these were cytologically benign without any atypia and/or mitosis, with few of them containing intraluminal secretions [Figure 1]a-d. The tumor invaded more than half the thickness of cervical stroma (Stage IB1) and the benign tubules also extended deep into the wall of cervix. Stromal cells around adenocarcinoma did not show any atypia. There were no areas of necrosis within the tumor and no lymphovascular emboli were noted. On immunohistochemistry, both the mesonephric hyperplasia and adenocarcinoma showed immunoreactivity for cytokeratin (CK) 7. In addition, both revealed focal luminal immunostaining for CD10. The adenocarcinoma component was negative for CK20, estrogen receptor (ER), progesterone receptor (PR), and carcinoembryonic antigen (CEA) [Figure 2]a-d. Vimentin staining was seen in the hyperplastic mesonephric remnants and was negative in the adenocarcinoma. Based on the presence of these morphological and immunohistochemical features, a diagnosis of mesonephric adenocarcinoma arising on a background of mesonephric hyperplasia was rendered.{Figure 1}{Figure 2}

Bilateral adnexal masses were histologically serous cystadenomas and bilateral pelvic lymph nodes were negative for metastasis. The patient received adjuvant radiotherapy (brachytherapy) and is recurrence free 6 months postoperatively.


Mesonephric adenocarcinoma is one of the rarest subtypes of cervical adenocarcinoma derived from remnants of the mesonephric ducts. [2],[4] Although it is recognized as a distinct subtype of adenocarcinoma in the World Health Organization's histologic classification of cervical epithelial tumors, very few cases have been reported in literature. [4],[5]

Mesonephric remnants consist of small cysts and/or tubules lined by bland cuboidal or low columnar nonciliated epithelium. The cytoplasm may appear clear or eosinophilic, but does not contain mucin (in contrast to endocervical epithelium) or glycogen. Characteristically, a densely eosinophilic, Periodic-acid Schiff-positive luminal secretion is present. Mesonephric hyperplasia, which is presumed to arise from mesonephric remnants, is an uncommon lesion and is most often an incidental finding. Ferry and Scully have proposed a maximum diameter of 6 mm to differentiate between mesonephric remnants and hyperplasia. [2] Mesonephric hyperplasia has been further divided into three categories: Lobular mesonephric hyperplasia, diffuse mesonephric hyperplasia, and pure mesonephric ductal hyperplasia. [2] The differential diagnosis of mesonephric hyperplasia includes mesonephric carcinoma, endocervical adenocarcinoma, and clear-cell carcinoma. The diffuse form of mesonephric hyperplasia can mimic a well-differentiated adenocarcinoma if it extends deeply into the cervical wall. A back-to-back pattern of glands, malignant nuclear features, and the presence of perineural or vascular invasion support the diagnosis of carcinoma. [3] In the present case, features of adenocarcinoma were present adjacent to hyperplastic remnants and the other unusual feature, hitherto undescribed, was the presence of these mesonephric remnants deep in the myometrium.

The diagnosis of malignant mesonephric tumors is challenging, as the pathologists need to be aware of the various morphologic patterns seen in these group of tumors. When mesonephric duct remnants and/or hyperplasia are found in the vicinity of the malignant neoplasm, as seen in our case, the diagnosis is usually straightforward. In a study of 11 cases of mesonephric adenocarcinoma, histological patterns described are ductal, tubular, retiform, solid, and a sex cord-like pattern. In 10 of these 11 cases, there were hyperplastic mesonephric remnants adjacent to the neoplastic element. [4] In the present case, the presence of squamous morules in the adenocarcinoma prompted us to include a primary endometrioid adenocarcinoma in the differential diagnosis. However, the associated mesonephric hyperplasia coupled with the lack of immunoreactivity to ER and PR (as expected in an endometrioid adenocarcinoma) favored the diagnosis of mesonephric adenocarcinoma.

Immunohistochemical evaluation may aid in differentiating these tumors from their Mullerian counterparts. Lang and Dallenbach-Hellweg [6] suggested that anti-CEA and anti-vimentin immunohistochemical stains would be useful in the differential diagnosis between cervical adenocarcinomas of mesonephric and Mullerian origin, the former being CEA negative and vimentin positive. Luminal CD10 positivity has also been shown in cervical mesonephric remnants and this antibody has been suggested as a useful immunohistochemical marker of mesonephric lesions in the female genital tract. Positive CD10 staining may be useful in confirming a mesonephric origin. Most other benign endocervical glandular lesions were totally negative with CD10. [7],[8] The present case also demonstrated characteristic CD10 luminal pattern of positivity, better appreciated in the hyperplastic mesonephric tubules. In a study of eight cases, most mesonephric adenocarcinomas were immunoreactive for vimentin and calretinin and negative for estrogen and progesterone receptors and CEA. [5] ER and PR were negative in our case.

Recently, PAX2 has been demonstrated in mesonephric remnants and in mesonephric hyperplasia, but not in adenocarcinomas of mesonephric origin. [9] PAX2 was not done in the present case due to non-availability of the antibody at our institute.

The biologic behavior, prognosis, and treatment strategies of this unusual tumor remain uncertain with some mesonephric adenocarcinomas displaying an aggressive clinical course. As there are no definite recommendations of a particular course of therapy for this uncommon disease, it would be reasonable to manage patients with mesonephric adenocarcinoma of the cervix according to current guidelines for cervical adenocarcinoma of similar stage and pathologic findings. [10] Hence, the present patient was managed with postoperative brachytherapy as per the guidelines.

In conclusion, we have reported a case of cervical mesonephric adenocarcinoma of endometrioid morphology with associated hyperplastic mesonephric remnants. A pathologist needs to be aware of this unusual entity with its various patterns so as to arrive at an accurate diagnosis.


The authors would like to acknowledge Dr Munita Bal, Associate Professor, Department of Pathology, Tata Memorial Hospital, Mumbai, for being associated with diagnosis of this case.


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