Mo N, He C Y, Yu H Y, Bian X T, Jin Y L
Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100006, China.
Zhonghua Bing Li Xue Za Zhi. 2022 Oct 8;51(10):1000-1006. doi: 10.3760/cma.j.cn112151-20220209-00088.
To investigate the clinicopathological features of proliferations with mesonephric features (PMF) of the gynecologic tract. A retrospective analysis was performed on the clinical and pathological data of 16 cases with PMF that were diagnosed from October 2016 to January 2022 at a single institution. The relevant literature was reviewed. Among the 16 cases, with an average of 53 years (31-68 years), there were 5 cases of mesonephric hyperplasia, 4 cases of mesonephric adenocarcinoma and 7 cases of mesonephric-like adenocarcinoma. The five cases of mesonephric hyperplasia were located in the lateral wall of the cervix and composed of simple tubules with growth patterns of diffuse or lobular clusters, without obvious stromal reaction. Four cases of mesonephric adenocarcinoma consisted of a mixture of papillary, cribriform, solid and other architectures, the nuclei resembling these of papillary thyroid carcinoma, and strong fibroproliferative reaction. They were located deep in the cervical and vaginal stroma. One of the tumors showed atypical mesonephric hyperplasia adjacent to the tumor. Five uterine and two ovarian mesonephric-like adenocarcinoma cases had similar histological morphology with mesonephric adenocarcinoma, but no mesonephric remnants/mesonephric hyperplasia were found near the tumors. In addition, four (4/5) uterine mesonephric-like adenocarcinoma cases originated from the endometrium with secondary involvement of myometrium, including one case with clear demarcation between the normal endometrium and the neoplastic glands. One (1/5) uterine mesonephric-like adenocarcinoma case was mainly located in the deep myometrium, along with adenomyosis around the tumor, without mesonephric remnants. Two ovarian mesonephric-like adenocarcinoma cases were associated with endometriotic cyst/endometrioid cystadenoma, including one case with an abrupt transition between normal epithelium and atypical mesonephric cells within the single individual cyst directly adjacent to tumor. All mesonephric hyperplasia and mesonephric adenocarcinoma cases were positive for GATA3, PAX8 and CD10 in a varying degree, and negative for ER, PR and TTF1. Although mesonephric-like adenocarcinoma showed a considerable overlap of immunohistochemical expression with mesonephric adenocarcinoma, seven mesonephric-like adenocarcinoma cases were positive for TTF1 and negative for GATA3. PMF is a class of rare proliferative lesions with morphological and immunophenotypic characteristics of mesonephric duct. Its commonly involved site, microscopic morphology, associated benign and/or atypical lesions, and immunophenotype may contribute to its diagnosis and differential diagnosis.
探讨女性生殖道具有中肾特征的增生性病变（PMF）的临床病理特征。对2016年10月至2022年1月在某单一机构诊断的16例PMF患者的临床和病理资料进行回顾性分析，并复习相关文献。16例患者平均年龄53岁（31 - 68岁），其中中肾增生5例，中肾腺癌4例，类中肾腺癌7例。5例中肾增生位于宫颈侧壁，由单纯小管组成，呈弥漫或小叶状生长，无明显间质反应。4例中肾腺癌由乳头、筛状、实性等结构混合组成，细胞核类似甲状腺乳头状癌，有强烈的纤维增生反应，位于宫颈和阴道间质深部，其中1例肿瘤旁可见非典型中肾增生。5例子宫和2例卵巢类中肾腺癌组织形态与中肾腺癌相似，但肿瘤附近未见中肾残余/中肾增生。此外，4例（4/5）子宫类中肾腺癌起源于子宫内膜并累及肌层，其中1例正常子宫内膜与肿瘤性腺管分界清晰。1例（1/5）子宫类中肾腺癌主要位于肌层深部，肿瘤周围伴有子宫腺肌病，无中肾残余。2例卵巢类中肾腺癌与子宫内膜异位囊肿/子宫内膜样囊腺瘤相关，其中1例在紧邻肿瘤的单个囊肿内正常上皮与非典型中肾细胞突然过渡。所有中肾增生和中肾腺癌病例GATA3、PAX8和CD10均不同程度阳性，ER、PR和TTF1均阴性。虽然类中肾腺癌免疫组化表达与中肾腺癌有相当程度重叠，但7例类中肾腺癌病例TTF1阳性，GATA3阴性。PMF是一类具有中肾管形态和免疫表型特征的罕见增生性病变。其常见累及部位、微观形态、相关良性和/或非典型病变及免疫表型有助于其诊断和鉴别诊断。
