Linck Jillian, Torres Wanda
Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, 3400 Gulf to Bay Blvd, Clearwater, FL 33759, USA.
Suncoast Women's Care, 2044 Trinity Oaks Blvd #125, Trinity, FL 34655, USA.
Case Rep Womens Health. 2023 Jul 28;39:e00531. doi: 10.1016/j.crwh.2023.e00531. eCollection 2023 Sep.
Mesonephric-like adenocarcinomas are newly classified rare neoplasms of the upper genital tract. They share identical features with mesonephric adenocarcinomas, with the exception of location. There is ongoing discussion on whether mesonephric-like adenocarcinomas arise from mesonephric remnants or are of Müllerian origin. A 65-year-old woman (G2P1) presented with pelvic pain. Transvaginal ultrasound revealed multiple fibroids, and a robotic total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was planned. Intraoperatively, a complex mass with cystic and solid components was found on the left ovary, which also adhered to the rectosigmoid colon. Pathologic reports documented mesonephric-like adenocarcinoma that appeared to be arising in association with an endometrioid adenofibroma. This case is notable due to the patient's unique background of in-utero exposure to diethylstilbestrol (DES) and multiple gynecological malignancies within her mother, as well as the associated endometrioid adenofibroma. This case contributes evidence to two seemingly opposing theories of mesonephric-like adenocarcinoma histogenesis: the mesonephric remnant theory (supported by the patient's DES exposure), and the Müllerian theory (supported by the associated endometrioid adenofibroma).
中肾样腺癌是上生殖道新分类的罕见肿瘤。它们与中肾腺癌具有相同的特征，只是位置不同。关于中肾样腺癌是起源于中肾残余还是苗勒管来源，目前仍在讨论中。一名65岁女性（G2P1）因盆腔疼痛就诊。经阴道超声检查发现多个子宫肌瘤，计划行机器人辅助全腹腔镜子宫切除术及双侧输卵管卵巢切除术。术中，在左侧卵巢发现一个有囊性和实性成分的复杂肿物，该肿物还与直肠乙状结肠粘连。病理报告显示为中肾样腺癌，似乎与子宫内膜样腺纤维瘤相关。该病例值得关注，因为患者有子宫内暴露于己烯雌酚（DES）的独特背景，其母亲患有多种妇科恶性肿瘤，以及与之相关的子宫内膜样腺纤维瘤。该病例为中肾样腺癌组织发生的两种看似对立的理论提供了证据：中肾残余理论（由患者暴露于DES支持）和苗勒管理论（由相关的子宫内膜样腺纤维瘤支持）。
