![]() ![]() ![]() All of the patients diagnosed at stage IV had a spindled cell component. However, these results should be interpreted with caution given the small number of patients.įour out of 24 patients diagnosed at stage I with adequate follow up available died of the disease, with a mean survival of 50 months. Patients with a stage I mesonephric AC had a recurrence rate of 32% and a mean recurrence interval of 24 months ( Table 2), compared to a reported recurrence rate of 11% for squamous cell carcinomas and 16% for adenocarcinomas in early stage cervical cancer ( Fregnani et al., 2008). Owing to the small number of cases with adequate follow-up, prognosis cannot be accurately predicted but it seems that mesonephric carcinomas carry a worse prognosis. However, the biological behavior of this unusual tumor remains unclear and until there are sufficient data to recommend a particular course of therapy it seems reasonable to manage patients with mesonephric adenocarcinoma of the cervix according to current guidelines for cervical adenocarcinoma of similar stage. There seems to be no difference in disease recurrence and mean recurrence interval between the patients with stage I mesonephric AC of the cervix treated merely surgically and those who received adjuvant therapy afterwards ( Table 2). No adjuvant treatment was given in patients with stage I disease except for radiotherapy in five patients with adenocarcinoma (AC) and chemotherapy in one patient with a mesonephric adenocarcinoma with spindled cell component (MMMT). ![]() All patients with stage I carcinoma, except for two, were treated with HRT and BSO, and LA was performed in eighteen patients (64%). In the present literature review the vast majority of patients (70%) were diagnosed at a stage I. In the 39 cases described in the literature, treatment depended on the stage of the disease and consisted of hysterectomy (HRT) with or without bilateral salpingo-oophorectomy (BSO), pelvic lymphadenectomy (LA) and (neo-) adjuvant chemo- or radiotherapy. The Ki-67 proliferation index is less than 1% in mesonephric hyperplasia compared to 15–20% in mesonephric carcinoma ( Silver et al., 2001). In contrast to mesonephric hyperplasia, a mesonephric carcinoma does not have a lobular architecture and the nuclei appear cytological malignant. The typical background lesion of a mesonephric carcinoma is florid mesonephric hyperplasia, characterized by a densely eosinophilic luminal secretion ( Menon et al., 2013). This is a biphasic variant of a mesonephric carcinoma with sarcomatoid features ( Clement et al., 1995, Yap et al., 2006). In this literature review 23% of the reported mesonephric carcinomas were associated with a spindled cell component (malignant mixed mesonephric tumor, MMMT). Therefore they are often confused with serous, clear cell or endometroid adenocarcinomas ( Anagnostopoulos et al., 2012, Nomoto et al., 2013). One of the most characteristic features of a mesonephric adenocarcinoma is that it exhibits a mixture of morphologic patterns. Tumor cells expressed p16, but chromogenic in situ hybridization did not demonstrate low- or high-risk Human Papillomavirus (HPV). The final diagnosis was a mesonephric adenocarcinoma of the cervix, FIGO stage IIB. Stainings for calretinin, carcinoembryonic antigen (CEA), estrogen and progesterone receptor (ER/PR) were negative. The lesion stained for cytokeratin 7, EMA and vimentin. The resection margins were free of tumor. There was extension to the isthmus and the paracervical fat tissue. The lesion measured 3 cm in greatest dimension. Histopathologic examination confirmed the presence of a mesonephric adenocarcinoma, predominantly on the right side, however, with almost complete circumferential extension. After the neoadjuvant therapy the patient underwent a type 2 Wertheim hysterectomy without pelvic lymphadenectomy. There was a limited reduction in size of the cervical mass to a volume of 37 × 23 × 30 mm. Given the presence of a bulky tumor with parametrial invasion, the patient underwent neoadjuvant chemoradiotherapy: 50 Gy (Gray) of Intensity Modulated Radiation Therapy (IMRT) in 25 fractions of 2 Gy daily and concomitant chemotherapy (Cisplatin) once a week. ![]()
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