Cervical mesonephric adenocarcinoma: A case report of a rare gynecological tumor from embryological remains of the female genital tract / Adenocarcinoma mesonéfrico cervical: Relato de caso de um tumor ginecológico raro de restos embriológicos do trato genital feminino

Abstract Introduction Malignant mesonephric tumors are uncommon in the female genital tract, and they are usually located where embryonic remnants of Wolffian ducts are detected, such as the uterine cervix. The information about these tumors, their treatment protocol, and prognosis are scarce. Case report A 60-year-old woman with postmenopausal vaginal bleeding was initially diagnosed with endometrial carcinoma. After suspicion co-testing, the patient underwent a loop electrosurgical excision of the cervix and was eventually diagnosed with mesonephric adenocarcinoma. She was subjected to a radical hysterectomy, which revealed International Federation of Gynecology and Obstetrics (FIGO) IB1 stage, and adjuvant radiotherapy. The follow-up showed no evidence of recurrence after 60 months. Conclusion We present the case of a woman with cervical mesonephric adenocarcinoma. When compared with the literature, this case had the longest clinical follow-up without evidence of recurrence, which reinforces the concept that these tumors are associated with a favorable prognosis if managed according to the guidelines defined for the treatment of patients with cervical adenocarcinomas. Though a rare entity, it should be kept in mind as a differential diagnosis for other cervical cancers.

Cervical Mesonephric Adenocarcinoma: A Case Report of a Rare Gynecological Tumor from Embryological Remains of the Female Genital Tract.

INTRODUCTION: Malignant mesonephric tumors are uncommon in the female genital tract, and they are usually located where embryonic remnants of Wolffian ducts are detected, such as the uterine cervix. The information about these tumors, their treatment protocol, and prognosis are scarce. CASE REPORT: A 60-year-old woman with postmenopausal vaginal bleeding was initially diagnosed with endometrial carcinoma. After suspicion co-testing, the patient underwent a loop electrosurgical excision of the cervix and was eventually diagnosed with mesonephric adenocarcinoma. She was subjected to a radical hysterectomy, which revealed International Federation of Gynecology and Obstetrics (FIGO) IB1 stage, and adjuvant radiotherapy. The follow-up showed no evidence of recurrence after 60 months. CONCLUSION: We present the case of a woman with cervical mesonephric adenocarcinoma. When compared with the literature, this case had the longest clinical follow-up without evidence of recurrence, which reinforces the concept that these tumors are associated with a favorable prognosis if managed according to the guidelines defined for the treatment of patients with cervical adenocarcinomas. Though a rare entity, it should be kept in mind as a differential diagnosis for other cervical cancers.

Pilo-sebaceous cystic ectopy of the uterine cervix.

The infrequent finding of pilo-sebaceous cysts in an uterine cervix is presented. The different histopathogenetic hypothesis and Literature reports are critically reviewed. The histogenesis can be referred to ectodermic embryonal germs which come in the ectopic site following an abnormal cephalic migration. Also stressed is the possibility that neoplasms of the pilo-sebaceous structures could arise in the ectopic site and, thereafter, due to their rarity, might be under-diagnosed at the histology.

Benign glandular inclusions in lymph nodes, endosalpingiosis, and salpingitis isthmica nodosa in a young girl with clear cell adenocarcinoma of the cervix.

A 12-year-old girl underwent radical surgery for clear cell adenocarcinoma of the endocervix. Bilaterally dilated fallopian tubes with hyperplastic mucosal folds and salpingitis isthmica nodosa were found in association with benign glandular inclusions in a para-aortic lymph node and in the serosa of pelvic organs. Changes in the müllerian-derived epithelium appear to be a common denominator of these unusual lesions in this young girl. A primary growth disturbance of the cells of the müllerian system, which was conditioned during embryonic development and manifested itself later in life in response to appropriate stimuli associated with menarche, is postulated as the underlying abnormality.

Prenatal diethylstilbestrol exposure and human genital tract abnormalities.

The incidence of clear cell adenocarcinoma of the vagina and cervix associated with intrauterine exposure to DES and similar compounds during the first half of pregnancy has increased. Ninety percent of these cancers have occurred in patients 14 years of age or older. Although these carcinomas are exceedingly rare, nonneoplastic abnormalities including vaginal adenosis, cervical eversion (ectropion), and transverse cervical and vaginal ridges are frequent in the exposed population, particularly if the drug was administered early in pregnancy. Current evidence favors a disturbance in development of the müllerian duct as the explanation of these changes. Whether DES is only a teratogen or also a carcinogen is unknown, as is the possible role of other factors in the development of cancer. An increased incidence of cancer among exposed males has not been documented.

Clear cell carcinoma of the uterine endocervix with an in situ component.

In the past all clear cell carcinomas of the female genital tract were thought to arise from mesonephric remnants. Recently increasing evidence has related their origin to müllerian rather than mesonephric epithelium. One of the main reasons that has been advanced to support their mesonephric origin has been their occurrence in the uterine cervix and vagina, sites of mesonephric remnants. However, no clear evidence for mesonephric origin of clear cell carcinoma of the cervix and vagina has been ever provided. In contrast, there is substantial evidence that diethylstilbestrol-related clear cell carcinomas of the cervix and vagina are müllerian in origin. We report here a case of an exophytic clear cell carcinoma with an in situ component, involving the endocervical epithelium. The in situ lesion clearly indicates müllerian origin of the tumor, which occurred in the absence of prenatal exposure to diethylstilbestrol. This supports the general agreement that clear cell carcinomas of the cervix are müllerian in origin, whether diethylstilbestrol-related or not.

Comparison of cancer cell surfaces of the lower reproductive tract by scanning electron microscopy.

The squamous cells of the cervix simulate those of the vagina and vulva both histologically and by scanning electron microscopy. However, in areas of the cervix undergoing active metaplasia, there are cells which share some of the characteristics demonstrated by scanning electron microscopy of both squamous and columnar epithelium. In these cells there is a wide range of characteristics of each cell type, suggesting a possible gradual transition from columnar to squamous epithelium. Furthermore, the cells of severe dysplasia and of intraepithelial and invasive squamous cancers of the cervix, though histologically similar to those of vaginal and vulvar cancers, are distinctly different when examined by scanning electron microscopy. These findings suggest that both metaplastic and neoplastic squamous cells are derived from the same progenitor columnar cells of the cervix, by orderly transition in the former and by atypical transformation in the latter. Second, the distinctiveness from the vaginal and vulvar cells indicates different embryonic stem cell lines.

Clear cell adenocarcinoma of the uterine cervix: a histological and histochemical study.

A case of Mullerian clear cell adenocarcinoma of the uterine cervix occurring in a young women is presented. A detailed histological and histochemical study of this type of tumour is important so as to separate it from the clear cell tumour of mesoenphric origin. The association of Mullerian clear cell adenocarcinoma and other abnormalities of the vagina and cervix with the administration of maternal nonsteroidal oestrogens has been recently stressed in the literature. However, our patient is illustrative of the 30-50% of cases reported to date which have few if any of the associated abnormalities of the genital tract and have no known exposure to non-steroidal oestrogens.

Carcinoma of the cervix with cylindromatous features believed to arise in mesonerphric duct.

A detailed description of the clinical and morphological aspects of a case of carcinoma of the cervix arising from mesonephric duct remnants is presented, and the literature pertaining to these rare tumors is discussed. At the time of initial surgical treatment the tumor was confined to the cervix; however, eventual metastatic dissemination to the bony and soft tissues of the pelvis, the lungs, and the lower vertebral column resulted in the patient's death 8 years later. The tumor appeared refractory to further attempts at treatment with radiation, progestational therapy, and variety of chemotherapeutic agents. The observation of a focal cylindromatous growth pattern, not previously described in tumors of this type, is presented.