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Review
. 2021 Feb 11;10(4):698.
doi: 10.3390/jcm10040698.

Mesonephric-Like Adenocarcinoma of the Endometrium: Diagnostic Advances to Spot This Wolf in Sheep's Clothing. A Review of the Literature

Ellen Deolet  1 , Jo Van Dorpe  1   2 , Koen Van de Vijver  1   2
Affiliations
Review

Mesonephric-Like Adenocarcinoma of the Endometrium: Diagnostic Advances to Spot This Wolf in Sheep's Clothing. A Review of the Literature

Ellen Deolet et al. J Clin Med. .

Abstract

Mesonephric-like adenocarcinoma is a recently described rare neoplasm occurring in the uterine corpus and ovary. This under-recognized subtype of carcinoma can be very challenging to diagnose. In mesonephric adenocarcinoma a variety of growth patterns can be present within the same tumor, as a result of which they can be misinterpreted and diagnosed as low-grade endometrioid adenocarcinoma, clear cell carcinoma, or even serous carcinoma and carcinosarcoma. We report a case of mesonephric-like adenocarcinoma misdiagnosed as a low-grade endometrioid endometrial adenocarcinoma that had an early local recurrence and metastasized to the liver and the lungs. Histopathological, immunohistochemical and molecular analysis were performed and compared to published literature, providing a comprehensive overview of the current knowledge. Databases (Pubmed, Web of Science, Google Scholar) were searched with a combination of the following search terms: mesonephric-like, mesonephric, adenocarcinoma, carcinoma, uterine body, uterine corpus, endometrium. Mesonephric-like adenocarcinoma is a difficult-to-diagnose entity. Advanced diagnostics, including improved morphologic, immunohistochemical and molecular knowledge can help develop new therapeutic strategies against this specific subtype of endometrial cancer with an aggressive clinical behavior.

Keywords: KRAS; endometrium; histology; immunohistochemistry; mesonephric-like adenocarcinoma; molecular; uterus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a–c). Metastasis to the lung with glandular and ductular to focal solid growth pattern. Several eosinophilic intraluminal secretions are present (c). No high-grade atypia and low mitotic figures. (magnification: 40×, 100×, 100×-HE staining).
Figure 2
Figure 2
Diffuse positive staining for PAX8 and GATA3. TTF1, SATB2, estrogen receptor (ER) and progesterone receptor (PR) are negative (PR shows minor non-specific cytoplasmic background staining). CD10 focal luminal positivity. Calretinin negative; p53 wild type staining. (magnification: 100×; immunohistochemistry).
Figure 3
Figure 3
Summary of immunohistochemical findings. Only cases where information was available of individual markers are included. Estrogen receptor (ER) and progesterone receptor (PR) are nearly always negative, with PR as a more reliable negative marker. Mesonephric-like adenocarcinomas (MLAs) are characterized by staining with GATA binding protein 3 (GATA3) and/or thyroid transcription factor 1 (TTF1) with sometimes a reversed staining pattern. CD10 was predominantly positive in the tested cases but mostly focal. Calretinin is more often negative. All cases showed Paired box protein-8 (PAX8) positivity and p53 wild type expression. (*) = negative for TP53 mutation.
See this image and copyright information in PMC

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