-
International Journal of Environmental... Nov 2022Mesonephric-like adenocarcinomas (MLA) are rare neoplasms that arise in the uterine body and ovary and have been added to the World Health Organisation's recent 2020...
Mesonephric-like adenocarcinomas (MLA) are rare neoplasms that arise in the uterine body and ovary and have been added to the World Health Organisation's recent 2020 classification of female genital cancers. The pathogenesis of MLA is unknown and it remains debated whether they represent mesonephric carcinomas (Wolffian) arising in the endometrium/ovary or endometrioid carcinomas (Müllerian) closely mimicking mesonephric carcinomas. Here we report the case of a 57-year-old woman with an initial misdiagnosis of endometrioid adenocarcinoma on diagnostic biopsy. The patient came to our clinical evaluation for the appearance of menometrorrhagia complicated by anemia for several months. Therefore, she underwent pelvic echo-flowmetry, with indication for diagnostic hysteroscopy with endometrial biopsy, which yielded a positive result for endometrioid endometrial adenocarcinoma. Following staging CT scan and targeted examinations on pulmonary findings, the patient underwent surgery with surprise of definitive diagnosis deponent for endometrial MLA. Our intention is to establish a brief review of the scientific evidence in the literature and the tools available for a correct histological diagnosis, in the light of the scant anatomopathological evidence. Our question gives rise to the motive for the publication: is immunohistochemistry the right way to resolve the diagnostic error at histology, which is usually the only source of diagnostic certainty? This case is intended to alert of diagnostic error that risked having the patient treated as a neoplasm with a favorable prognosis and low degree of aggressiveness instead of for a very aggressive and poor prognosis tumor such as MLA.
Topics: Humans; Female; Middle Aged; Adenocarcinoma; Carcinoma, Endometrioid; Immunohistochemistry; Endometrium; Biomarkers, Tumor
PubMed: 36361332
DOI: 10.3390/ijerph192114451 -
Diagnostics (Basel, Switzerland) Sep 2020Mesonephric adenocarcinoma is a rare tumor that is considered to develop from mesonephric remnants of the female genital tract. This tumor usually occurs in the lateral...
Mesonephric adenocarcinoma is a rare tumor that is considered to develop from mesonephric remnants of the female genital tract. This tumor usually occurs in the lateral wall of the uterine cervix. Herein, we present an exceptionally rare case of mesonephric adenocarcinoma located in the uterine fundus. The tumor exhibited intense hypermetabolism on F-FDG PET/CT. Based on the characteristic histologic features and immunohistochemical phenotypes, the diagnosis of mesonephric adenocarcinoma was confirmed. The patient underwent hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection, and no lymph node or distant metastasis was identified. After 20 months of surveillance without adjuvant therapy, she remains free of relapse.
PubMed: 32967381
DOI: 10.3390/diagnostics10090729 -
Indian Journal of Nephrology 2023Mesonephric remnants persist as an appendix of epididymis and paradidymis in efferent ductules in males and skene's glands and Gartner's ducts in females. The...
Mesonephric remnants persist as an appendix of epididymis and paradidymis in efferent ductules in males and skene's glands and Gartner's ducts in females. The mesonephric remnant in the renal parenchyma is extremely rare and only a few cases have been reported in the literature. We present a case with a non-functioning atrophic left kidney. Histopathology showed variable-sized ducts filled with colloid-like material surrounded by collagenized stroma. The ureter showed hypertrophied muscle and a few ducts lined by flattened and a few by columnar epithelium resembling epididymis suggestive of mesonephric remnants. IHC for CD10, PAX 8, and GATA3 was positive. A diagnosis of congenital unilateral hypoplasia of kidneys and ureter with mesonephric remnants was given.
PubMed: 37881746
DOI: 10.4103/ijn.IJN_579_20 -
Animals : An Open Access Journal From... Aug 2021It was the aim of this study to characterize the development of the gonads and genital ducts in the equine fetus around the time of sexual differentiation. This included...
It was the aim of this study to characterize the development of the gonads and genital ducts in the equine fetus around the time of sexual differentiation. This included the identification and localization of the primordial germ cell population. Equine fetuses between 45 and 60 days of gestation were evaluated using a combination of micro-computed tomography scanning, immunohistochemistry, and multiplex immunofluorescence. Fetal gonads increased in size 23-fold from 45 to 60 days of gestation, and an even greater increase was observed in the metanephros volume. Signs of mesonephros atrophy were detected during this time. Tubular structures of the fetal testes were present from day 50 onwards, whereas cell clusters dominated in the fetal ovary. The genital ducts were well-differentiated and presented a lumen in all samples. No sign of mesonephric or paramesonephric duct degeneration was detected. Expression of AMH was strong in the fetal testes but absent in ovaries. Irrespective of sex, primordial germ cells selectively expressed LIN28. Migration of primordial germ cells from the mesonephros to the gonad was detected at 45 days, but not at 60 days of development. Their number and distribution within the gonad were influenced ( < 0.05) by fetal sex. Most primordial germ cells (86.8 ± 3.2% in females and 84.6 ± 4.7% in males) were characterized as pluripotent according to co-localization with CD117. However, only a very small percentage of primordial germ cells were proliferating (7.5 ± 1.7% in females and 3.2 ± 1.2% in males) based on co-localization with Ki67. It can be concluded that gonadal sexual differentiation in the horse occurs asynchronously with regard to sex but already before 45 days of gestation.
PubMed: 34438878
DOI: 10.3390/ani11082422 -
Archives of Pathology & Laboratory... Jun 2022Gender-affirming surgery is part of a multidisciplinary approach in gender transitioning. Deeper histologic examination may strengthen care for transmasculine...
CONTEXT.—
Gender-affirming surgery is part of a multidisciplinary approach in gender transitioning. Deeper histologic examination may strengthen care for transmasculine individuals and increase the understanding of the influence of hormonal therapy in specific organs.
OBJECTIVE.—
To evaluate and catalogue histologic findings of tissue obtained from gender-affirming gynecologic surgery and cervical cytology specimens.
DESIGN.—
This is an institutional review board-approved retrospective study that included transmasculine individuals who underwent gender-affirming gynecologic surgery from January 2015 to June 2020. All surgical gynecologic pathology and cervical cytology slides were reviewed by 2 pathologists.
RESULTS.—
Fifty-five patients were included, which represented 40 uteri, 35 bilateral ovaries, 15 vaginectomy specimens, and 24 cervical cytology results. The median age was 27 years (range, 18-56), and 94% (50 of 53) of patients were receiving testosterone for at least 1 year. Seventy-five percent (30 of 40) of endometria were inactive, while 25% (10 of 40) showed evidence of cycling. Transitional cell metaplasia was the most common finding in the cervix (17 of 40) and vagina (15 of 15), reflecting a high percentage (4 of 24) of unsatisfactory or ASC-US (atypical squamous cells of undetermined significance) cervical cytologies. Prostatic-type glands were identified in 20% (8 of 40) of cervices and 67% (10 of 15) of vaginectomy specimens. Multiple bilateral cystic follicles and evidence of follicular maturation were present in 57% (20 of 35) of cases. Four cases showed paratubal epididymis-like mesonephric remnant hypertrophy.
CONCLUSIONS.—
A comprehensive evaluation of tissue from gender-affirming surgery increases knowledge of the changes following androgen therapy in transmasculine individuals and may contribute to optimal patient care by raising awareness of normal histologic variations in this population.
Topics: Adult; Cervix Uteri; Female; Humans; Male; Metaplasia; Prostate; Retrospective Studies; Uterus
PubMed: 34591101
DOI: 10.5858/arpa.2021-0199-OA -
Developmental Dynamics : An Official... Dec 2020The rete testis connects seminiferous tubules of the testis with efferent ducts having a mesonephric origin. The development of the rete testis is insufficiently...
BACKGROUND
The rete testis connects seminiferous tubules of the testis with efferent ducts having a mesonephric origin. The development of the rete testis is insufficiently studied, but there is evidence suggesting that it originates from gonadal cells. Here, the formation of the rete testis was investigated from E11.5 to E16.5 using immunofluorescent staining and 3D-modeling.
RESULTS
The rete testis became visible by SOX9 and PAX8 staining starting from E12.5. It was located in the mesonephros but connected with testis cords formed by Sertoli cells expressing SOX9, AMH, DMRT1. Between E13.5 and E14.5, AMH+ network of testis cords at the mesonephric side began to disintegrate in a gradient-dependent manner along the anterior-posterior axis of the gonad and connections between testis cords gradually lost AMH becoming a part of the rete. Cells combining features of Sertoli and rete cells (PAX8+ AMH+ and DMRT1+ AMH- cells) were detected starting from E14.5, suggesting that some rete cells originated from Sertoli cells. The rete ovarii, a female counterpart of the rete testis, developed in a similar way as the rete testis until E13.5.
CONCLUSIONS
A part of the rete testis originates from connections between testis cords. Evidence that Sertoli cells contribute to rete cells is provided.
Topics: Animals; Embryonic Development; Male; Mice; Rete Testis; Sertoli Cells
PubMed: 32852840
DOI: 10.1002/dvdy.242 -
Cancer Cytopathology Aug 2019Mesonephric adenocarcinomas are rare neoplasms which most commonly arise in the lateral cervix and vagina. Tumors with similar morphologic, immunophenotypic, and...
BACKGROUND
Mesonephric adenocarcinomas are rare neoplasms which most commonly arise in the lateral cervix and vagina. Tumors with similar morphologic, immunophenotypic, and molecular characteristics recently have been described in the uterine corpus and ovary. Herein, the authors sought to characterize the cytomorphologic features of adenocarcinomas exhibiting mesonephric-like differentiation arising in the upper gynecologic tract.
METHODS
Institutional databases were queried retrospectively for tumors of the upper gynecologic tract described as a "tumor of Wolffian origin" or "with mesonephric features" between 2007 and 2017. All available cytologic material was reviewed. Cytomorphologic characteristics were evaluated by 3 pathologists.
RESULTS
The current study cohort consisted of 8 cases taken from 7 patients. Primary sites included the ovary (3 cases); endometrium (4 cases); and pelvis, not otherwise specified (1 case). All cases demonstrated tight 3-dimensional clusters of overlapping cells. Additional architectural features included tubular (5 of 8 cases; 63%) and papillary (3 of 8 cases; 38%) formations. Cells were small with scant (7 of 8 cases; 88%) to moderate (1 of 8 cases; 12%) cytoplasm. Three of the 8 cases (38%) demonstrated extracellular hyaline globules. Nuclei were uniform in size (6 of 8 cases; 75%) or showed mild anisonucleosis (2 of 8 cases; 25%). Nuclear grooves and indentations were observed in all cases. Mitoses (5 of 8 cases; 63%) and apoptotic bodies (4 of 8 cases; 50%), when present, were rare. No necrosis was noted.
CONCLUSIONS
Adenocarcinomas exhibiting mesonephric-like differentiation show a monotonous population of small cells with scant to moderate cytoplasm and abundant nuclear grooves arranged in tight, overlapping, 3-dimensional clusters. Occasionally, papillary or tubular architecture, as well as extracellular hyaline globules, may be seen. These features should prompt further testing (eg, immunohistochemistry) to confirm the diagnosis and to exclude potential mimics.
Topics: Adenocarcinoma; Adult; Aged; Endometrial Neoplasms; Endometrium; Female; Humans; Mesonephroma; Middle Aged; Ovarian Neoplasms; Ovary; Retrospective Studies
PubMed: 31318491
DOI: 10.1002/cncy.22160 -
Clinical Case Reports Jun 2023Splenic tissue outside the normal anatomical site can be collectively referred to as ectopic spleen. Clinically, the commonest causes of ectopic spleen include accessory...
Splenic tissue outside the normal anatomical site can be collectively referred to as ectopic spleen. Clinically, the commonest causes of ectopic spleen include accessory spleen, splenic tissue implantation, and splenogonadal fusion (SGF). Accessory spleen is mostly caused by congenital dysplasia, is mostly located near the spleen, and may be supplied by the splenic artery. Splenic implantation is mostly caused by autologous spleen tissue transplantation caused by trauma or surgery. SGF is the abnormal fusion of the spleen with the gonad or with the mesonephric derivatives. As a rare developmental malformation, it is difficult to make a correct diagnosis preoperatively, and easily misdiagnosed as a testicular tumor cause lifelong harm to patients. An 18-year-old male student who developed left testicular pain without obvious cause that radiated to the perineum 4 months prior to presentation. He was diagnosed with cryptorchidism 12 years ago and underwent orchiopexy without intraoperative frozen section examination. An ultrasound was performed, identifying hypoechoic nodules in the left testis, suggestive of seminoma. During surgery, the testicular tumor revealed a dark red tissue and the diagnosis of a pathological ectopic splenic tissue was made. Because the clinical manifestations of SGF are not specific, misdiagnosis and unnecessary orchiectomy may occur. If a complete preoperative examination which includes biopsy or intraoperative frozen section is performed, unnecessary orchiectomy can be effectively avoided and bilateral fertility can be preserved.
PubMed: 37305869
DOI: 10.1002/ccr3.7264 -
Annals of Medicine and Surgery (2012) Jul 2022and importance: Zinner syndrome is a rare congenital malformation of the seminal vesicles and the homolateral upper urinary tract. While the majority of patients remain...
INTRODUCTION
and importance: Zinner syndrome is a rare congenital malformation of the seminal vesicles and the homolateral upper urinary tract. While the majority of patients remain asymptomatic and are discovered incidentally, others present symptoms such as micturition or ejaculatory difficulties, or pain. We report a case of Zinner syndrome in a 32-year-old patient with painful ejaculation and discuss the diagnosis and treatment difficulties.
CASE PRESENTATION
A 32-year-old married patient was consulted for pelvic pain associated with painful ejaculation that had been evolving for six months. The clinical examination was normal. Routine laboratory studies of blood and urine were normal. The patient was explored by ultrasound which showed the absence of the right kidney and the presence of a 7 cm right lateral prostatic cystic mass. On MRI, the right kidney was not visualized. Multiple cysts were seen in the right seminal vesicle. Surgical excision of the cyst by laparotomy was performed. The patient had an uneventful recovery and was discharged on the third postoperative day.
CLINICAL DISCUSSION
Congenital malformations of the seminal vesicles are often associated with those of the ipsilateral upper urinary tract, as the ureteral and seminal vesicle buds originate from the mesonephric duct. The syndrome often occurs in the second and third decades of life, especially after the onset of sexual activity. The most common symptoms were dysuria, perineal pain, epididymitis, and painful ejaculation. Diagnostic modalities include ultrasound, MRI, and cystoscopy. In patients with symptoms, the therapeutic management of the cyst includes ultrasound-guided aspiration and laparoscopic or open surgical excision.
CONCLUSION
Seminal vesicle cysts associated with homolateral renal agenesis or hypoplasia are a rare urologic anomaly. The treatment depends on the patient's symptoms. surgical excision of seminal vesicle cysts may be needed for large cysts causing obstructive symptoms.
PubMed: 35860150
DOI: 10.1016/j.amsu.2022.103982 -
Archives of Pathology & Laboratory... Jul 2021While the vast majority of cervical tumors consist of human papillomavirus (HPV)-related squamous cell carcinoma or adenocarcinoma, a subset of rare tumor types,...
CONTEXT.—
While the vast majority of cervical tumors consist of human papillomavirus (HPV)-related squamous cell carcinoma or adenocarcinoma, a subset of rare tumor types, frequently unrelated to HPV, does occur in this location. These tumors vary widely in prognostic and therapeutic implications, and accurate recognition is crucial to providing appropriate treatment. Some are benign or portend a favorable prognosis (adenoid basal carcinoma, ectopic prostate tissue), while others are frankly malignant lesions with a less favorable prognosis (adenoid cystic carcinoma, HPV-negative endocervical adenocarcinoma, mesonephric adenocarcinoma, clear cell carcinoma, small cell carcinoma, and adenosquamous carcinoma).
OBJECTIVE.—
To review the morphologic features of uncommon cervical lesions, the utility of immunohistochemistry for distinction between these entities, and the clinical and prognostic implications of accurate diagnosis.
DATA SOURCES.—
University of Michigan cases and review of the pertinent literature regarding the entities described.
CONCLUSIONS.—
Key morphologic and immunohistochemical features detailed herein will allow for the accurate distinction between these uncommon cervical lesions. Morphology is most useful in discriminating between the entities, as there is frequent immunohistochemical overlap between them; however, in rare instances immunohistochemistry can be useful in resolving the diagnosis.
Topics: Biomarkers, Tumor; Biopsy; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Papillomaviridae; Papillomavirus Infections; Predictive Value of Tests; Reproducibility of Results; Uterine Cervical Neoplasms
PubMed: 33091926
DOI: 10.5858/arpa.2020-0327-RA