Pb. Clement et al., MALIGNANT MESONEPHRIC NEOPLASMS OF THE UTERINE CERVIX - A REPORT OF 8CASES, INCLUDING 4 WITH A MALIGNANT SPINDLE-CELL COMPONENT, The American journal of surgical pathology, 19(10), 1995, pp. 1158-1171
Eight mesonephric adenocarcinomas of the uterine cervix, four of which
had a malignant spindle-cell component, occurred in women aged 34 to
71 (median 43, mean 54.5) years, bringing to 14 the number of cervical
mesonephric carcinomas in the literature. The tumors with a malignant
spindle-cell component (''malignant mesonephric mixed tumors'') are,
with one possible exception, the first reported examples at this site.
The patients, almost all of whom presented with vaginal bleeding, und
erwent hysterectomy; five also had a pelvic lymph node dissection. The
tumors were all stage IB, although microscopic lymph node metastases
were found in two cases. Gross examination revealed an invasive cervic
al mass in each case. On microscopic examination, seven tumors were ad
jacent to mesonephric hyperplasia, which in five cases was florid and
focally atypical; in the remaining case, occasional non-neoplastic mes
onephric tubules were found only within the tumor. The adenocarcinomas
typically exhibited a variety of patterns, including a ductal pattern
resembling endometrioid adenocarcinoma, a small tubular pattern, a re
tiform pattern, a solid pattern, and a sex-cord-like pattern. These di
sparate patterns frequently caused diagnostic difficulty. The spindle-
cell component generally resembled endometrial stromal sarcoma or a no
nspecific spindle-cell sarcoma; one tumor also contained multiple foci
of osteosarcoma and another, a single chondroid focus. Immunohistoche
mical staining for a variety of antigens failed to reveal a distinctiv
e profile, although all the carcinomas were immunoreactive for vimenti
n. Follow-up in six cases revealed three patients to be alive without
evidence of recurrence at postoperative intervals of 2 to 3 years. Rec
urrent tumor developed in a fourth patient 1 year after hysterectomy;
she was treated with chemotherapy and was alive and free of disease at
2 years. Another patient had intra-abdominal recurrences (including l
iver metastases) at 9 and 11 years and was alive with tumor at 13 year
s. Death at 8.5 months in a final patient was probably due to an indep
endent stage IIc ovarian clear-cell carcinoma. These and prior observa
tions in the literature suggest that malignant mesonephric tumors of t
he cervix may be more indolent than their mullerian counterparts, from
which they should be distinguished. Mesonephric carcinomas in this si
te should also be distinguished from florid mesonephric hyperplasia, w
ith which they are usually associated.