Mesonephric adenocarcinomas of the uterine cervix - A study of 11 cases with immunohistochemical findings

Mesonephric adenocarcinoma is a rare variant of cervical carcinoma with rel atively few, well-documented cases reported. We describe the clinicopatholo gic and immunohistochemical features of 11 examples of this neoplasm, which occurred in women between the ages of 35 and 72 years (mean, 52 years). Mo st (64%) patients had abnormal vaginal bleeding. Eight tumors were stage IB , and one each was stage IIB and IVB; in one, the stage was unknown. Micros copically, the carcinomas showed various morphologies, most commonly a smal l tubular pattern or a ductal pattern resembling endometrioid adenocarcinom a; one tumor had an associated malignant spindle cell component. Ten neopla sms were adjacent to hyperplastic mesonephric remnants. Follow-up in 10 cas es showed six patients to be alive without evidence of recurrence after a m ean of 4.8 years. The patients with stage IIB and IVB disease had local rec urrences after 2.2 and 0.7 years and died of progressive disease at 3.2 and 0.8 years, respectively. In a patient with stage IB disease, a mediastinal metastasis and a malignant pleural effusion developed 5.6 years after diag nosis, and the patient died of disease at 6.2 years. Another patient with s tage IB disease and a positive vaginal cuff margin that recurred locally af ter 1.7 years received chemotherapy and was alive and clinically free of di sease at 2.5 years. Mesonephric adenocarcinomas were immunoreactive for epi thelial markers (AE1/3; CK1, CAM 5.2, cytokeratin 7, and epithelial membran e antigen) (100%), calretinin (88%), vimentin (70%), androgen receptor (33% ), and inhibin (30%, focal staining). No immunostaining was detected with c ytokeratin 20, estrogen receptor, progesterone receptor, and monoclonal car cinoembryonic antigen. This staining profile is similar to that of mesoneph ric remnants and may be useful in the distinction of mesonephric carcinoma from mullerian endometrioid adenocarcinoma, with which it may be confused.