Yuan J, Chen T T, Chen X C, Ning Y, Tao X, Gu W Y
Department of Pathology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing 314000, China.
Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200090, China.
Zhonghua Bing Li Xue Za Zhi. 2025 May 8;54(5):494-499. doi: 10.3760/cma.j.cn112151-20241113-00752.
To investigate the clinicopathological characteristics, diagnosis, origin, and prognosis of primary ovarian mesonephric-like adenocarcinoma. A total of 17 cases of primary ovarian mesonephric-like adenocarcinoma diagnosed at the Obstetrics and Gynecology Hospital of Fudan University and Jiaxing Maternal and Child Health Care Hospital between January 2018 and September 2024 were included in this study. Histopathological sections were retrospectively reviewed, and clinicopathological data were systematically analyzed. Immunohistochemical analysis, molecular profiling, and clinical follow-up were performed to further characterize the cases. The patients' age was (57.1±9.3) years. Tumor involvement included 1 bilateral case, 9 left-sided cases, and 7 right-sided cases. Nine cases originated from endometrioid cysts, and 8 cases exhibited coexisting tumor components of other types. Gross examination revealed gray-yellow solid masses or solid components within cysts. Microscopically, the tumors displayed diverse architectural patterns, including papillary, glandular, cystic, tubular, and solid structures, with eosinophilic secretions within glandular lumens and mild to moderate nuclear atypia. Immunohistochemically, the tumors showed variable expression of TTF1, GATA3, CD10, and Calretinin. ER and PR were focally positive in only 2 cases, while others were negative. All cases demonstrated intact DNA mismatch repair proteins expression and wild-type p53 staining patterns. Molecular analysis performed in 10 cases identified pathogenic KRAS mutations in all tested samples. During a follow-up period of 1 to 75 months, 5 cases had recurrence, 1 patient remained alive with disease, and no disease-related death was reported. Ovarian mesonephric-like adenocarcinoma is an aggressive malignancy with a high potential for early recurrence and metastasis. Its frequent association with endometriosis and coexistence with other Müllerian tumors suggest a potential Müllerian origin. The tumor's diverse morphological spectrum and common admixture with other tumor types often pose diagnostic challenges, making it difficult to distinguish from other gynecological malignancies. Therefore, accurate diagnosis of ovarian mesonephric-like adenocarcinoma is crucial for appropriate clinical management and prognostication.
探讨原发性卵巢中肾样腺癌的临床病理特征、诊断、起源及预后。本研究纳入了2018年1月至2024年9月期间在复旦大学附属妇产科医院和嘉兴市妇幼保健院确诊的17例原发性卵巢中肾样腺癌病例。对组织病理学切片进行回顾性分析，并对临床病理数据进行系统分析。进行免疫组化分析、分子谱分析及临床随访以进一步明确这些病例的特征。患者年龄为（57.1±9.3）岁。肿瘤累及情况包括1例双侧病例、9例左侧病例和7例右侧病例。9例起源于子宫内膜样囊肿，8例伴有其他类型的肿瘤成分。大体检查显示为灰黄色实性肿块或囊肿内的实性成分。显微镜下，肿瘤呈现多种结构模式，包括乳头状、腺管状、囊性、管状和实性结构，腺腔内可见嗜酸性分泌物，核异型性为轻度至中度。免疫组化方面，肿瘤TTF1、GATA3、CD10和钙视网膜蛋白表达各异。仅2例雌激素受体（ER）和孕激素受体（PR）局灶阳性，其余均为阴性。所有病例均显示DNA错配修复蛋白表达完整及p53染色模式为野生型。对10例进行的分子分析在所有检测样本中均鉴定出致病性KRAS突变。随访1至75个月期间，5例复发，1例带瘤生存，未报告与疾病相关的死亡。卵巢中肾样腺癌是一种侵袭性恶性肿瘤，早期复发和转移潜力高。其常与子宫内膜异位症相关且与其他苗勒管肿瘤共存提示可能起源于苗勒管。肿瘤多样的形态谱及常与其他肿瘤类型混合的情况常带来诊断挑战，难以与其他妇科恶性肿瘤区分。因此，准确诊断卵巢中肾样腺癌对于恰当的临床管理和预后评估至关重要。
