Department of Diagnostic Pathology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Department of Gynecology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Int J Surg Pathol. 2024 May;32(3):578-585. doi: 10.1177/10668969231183631. Epub 2023 Jun 21.
Ovarian mesonephric-like adenocarcinoma (MLA) is a rare cancer subtype. We describe a patient with ovarian MLA wherein liver metastases developed 1 month after surgery. A phenotypic analysis of the tumor was performed to identify molecular therapeutic targets. A 53-year-old woman, without any symptoms, underwent uterine cancer screening. Transvaginal ultrasonography revealed an ovarian mass, and subsequent pelvic magnetic resonance imaging showed a 13 × 10 cm multicystic ovarian lesion with a solid part. No extra ovarian lesions were observed and a staging laparotomy was performed. Pathological examination revealed an MLA of the left ovary (stage IC1). The tumor comprised tumor cells in a tubular pattern with intraluminal eosinophilic material, as well as mixed glandular and papillary, cord-like, and solid patterns. Endometriosis was also observed. Immunohistochemically, the tumor cells were positive for PAX8, GATA3 (focal), TTF1 (focal), and CD10 (luminal) and negative for the estrogen receptor, progesterone receptor, and WT1. One month after surgery, computed tomography revealed multiple liver metastases. Additional immunohistochemistry for therapeutic targets revealed that the tumor cells were weakly positive for human epidermal growth factor receptor 2 (focal; score 1+), pan-tropomyosin receptor kinase-negative, programmed death-ligand 1-negative, and PMS2 and MSH6 intact. The companion homologous recombination deficiency test (MyChoice) showed homologous recombination repair proficiency. These findings suggest that poly(ADP-ribose) polymerase inhibitors and immune checkpoint inhibitors may not be effective treatment options. A literature review revealed that data on therapeutic targets in MLA are scarce. In summary, we report a patient with ovarian MLA showing an aggressive clinical course and the phenotypic analysis of the tumor may contribute to the identification of therapeutic targets for MLA.
卵巢苗勒管混合性癌（MLA）是一种罕见的癌症亚型。我们描述了一例卵巢 MLA 患者，其术后 1 个月发生肝转移。对肿瘤进行表型分析以确定分子治疗靶点。一名 53 岁女性，无症状，行子宫癌筛查。经阴道超声检查发现卵巢肿块，随后盆腔磁共振成像显示左卵巢 13×10cm 多房囊性病变伴实性部分。未观察到卵巢外病变，并进行分期剖腹探查。病理检查显示左侧卵巢 MLA（IC1 期）。肿瘤由管状排列的肿瘤细胞组成，管腔内有嗜酸性物质，还有混合性腺和乳头状、索状和实性排列。还观察到子宫内膜异位症。免疫组化染色显示肿瘤细胞 PAX8、GATA3（局灶性）、TTF1（局灶性）和 CD10（管腔）阳性，雌激素受体、孕激素受体和 WT1 阴性。术后 1 个月，计算机断层扫描显示多发肝转移。针对治疗靶点的额外免疫组化显示肿瘤细胞人表皮生长因子受体 2（局灶性；评分 1+）弱阳性、全 tropomyosin 受体激酶阴性、程序性死亡配体 1 阴性、PMS2 和 MSH6 完整。同源重组缺陷检测（MyChoice）显示同源重组修复能力正常。这些发现提示多聚（ADP-核糖）聚合酶抑制剂和免疫检查点抑制剂可能不是有效的治疗选择。文献复习显示 MLA 治疗靶点的数据很少。总之，我们报告了一例卵巢 MLA 患者表现出侵袭性临床病程，肿瘤的表型分析可能有助于确定 MLA 的治疗靶点。
