Maeda Shinichiro, Miki Michiyasu, Aoki Takuya, Yoshioka Shinya, Hara Shigeo
Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, JPN.
Department of Obstetrics and Gynecology, Kyoto Okamoto Memorial Hospital, Kyoto, JPN.
Cureus. 2025 Jul 21;17(7):e88468. doi: 10.7759/cureus.88468. eCollection 2025 Jul.
Mesonephric adenocarcinoma is a clinically aggressive, rare malignant neoplasm characterized by mesonephric (Wolffian) differentiation. It can occur throughout the female genital tract; however, most cases arise in the uterine cervix. Vaginal mesonephric adenocarcinoma is uncommon, and cases with a concomitant sarcomatous component are extremely rare. Using appropriate immunohistochemistry, we present a rare case of a primary malignant mixed mesonephric tumor of the vagina, defined by biphasic epithelial and mesenchymal malignant components of mesonephric origin. The patient was a 34-year-old woman who presented with vaginal pain and bleeding. Pelvic examination and diagnostic imaging revealed a primary vaginal tumor measuring approximately 4 cm without distant metastases. Histological examination of the biopsy specimen revealed an adenocarcinoma with a sarcomatous component. Our initial diagnosis was primary vaginal carcinosarcoma; however, additional immunohistochemistry of the tumor revealed luminal membranous positivity for CD10, diffuse nuclear staining for TTF1, and estrogen receptor negativity. These findings led to a final diagnosis of a primary malignant mixed mesonephric tumor of the vagina. Because of the patient's young age and desire for fertility preservation, curative concurrent chemoradiation was performed after oocyte and ovarian cryopreservation and migration via laparoscopic surgery. The tumor showed a marked reduction in size within three months and remained under control. This case emphasizes the need for clinicians and pathologists to consider the possibility of a mesonephric origin when encountering vaginal adenocarcinoma with a sarcomatous component. Appropriate immunohistochemical analysis is essential for establishing an accurate diagnosis and developing effective therapeutic strategies.
中肾腺癌是一种临床上具有侵袭性的罕见恶性肿瘤，其特征为中肾（沃尔夫管）分化。它可发生于整个女性生殖道；然而，大多数病例发生在子宫颈。阴道中肾腺癌并不常见，伴有肉瘤成分的病例极为罕见。通过适当的免疫组织化学方法，我们报告了一例罕见的原发性阴道恶性混合性中肾肿瘤病例，其由中肾来源的双相上皮和间充质恶性成分所定义。患者为一名34岁女性，表现为阴道疼痛和出血。盆腔检查和诊断性影像学检查发现一个原发性阴道肿瘤，大小约4厘米，无远处转移。活检标本的组织学检查显示为伴有肉瘤成分的腺癌。我们最初的诊断是原发性阴道癌肉瘤；然而，对肿瘤进行的进一步免疫组织化学检查显示CD10呈管腔膜阳性、TTF1呈弥漫性核染色、雌激素受体阴性。这些发现最终诊断为原发性阴道恶性混合性中肾肿瘤。由于患者年轻且有保留生育功能的愿望，在通过腹腔镜手术进行卵母细胞和卵巢冷冻保存及移位后，进行了根治性同步放化疗。肿瘤在三个月内显著缩小并得到控制。该病例强调，临床医生和病理学家在遇到伴有肉瘤成分的阴道腺癌时，需要考虑中肾起源的可能性。适当的免疫组织化学分析对于准确诊断和制定有效的治疗策略至关重要。
