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Extrauterine Mesonephric-like Neoplasms: Expanding the Morphologic Spectrum.
The American Journal of Surgical Pathology ( IF 5.6 ) Pub Date : 2021-06-29 , DOI: 10.1097/pas.0000000000001766
Ellen Deolet 1 , Iteeka Arora 2 , Jo Van Dorpe 1 , Joni Van der Meulen 3 , Sudha Desai 4 , Nadine Van Roy 3 , Baljeet Kaur 2 , Koen Van de Vijver 1 , W Glenn McCluggage 5
Affiliation  

Mesonephric-like adenocarcinomas (MLA) are rare neoplasms arising in the uterine corpus and ovary which have been added to the recent 2020 World Health Organization Classification of Female Genital Tumors. They have similar morphology and immunophenotype and exhibit molecular aberrations similar to cervical mesonephric adenocarcinomas. It is debated as to whether they are of mesonephric or Mullerian origin. We describe the clinical, pathologic, immunohistochemical, and molecular features of 5 cases of extrauterine mesonephric-like proliferations (4 ovary, 1 extraovarian), all with novel and hitherto unreported features. These include an origin of MLA in extraovarian endometriosis, an association of ovarian MLA with high-grade serous carcinoma, mixed germ cell tumor and mature teratoma, and a borderline ovarian endometrioid tumor exhibiting mesonephric differentiation. Four of the cases exhibited a KRAS variant and 3 also a PIK3CA variant. In reporting these cases, we expand on the published tumor types associated with MLA and report for the first time a borderline tumor exhibiting mesonephric differentiation. We show the value of molecular testing in helping to confirm a mesonephric-like lesion and in determining the relationship between the different neoplastic components. We provide further evidence for a Mullerian origin, rather than a true mesonephric origin, in some of these cases. We also speculate that in the 2 cases associated with germ cell neoplasms, the MLA arose out of the germ cell tumor.

中文翻译:

宫外中肾样肿瘤:扩大形态谱。

中肾样腺癌 (MLA) 是发生于子宫体和卵巢的罕见肿瘤,已被添加到最近的 2020 年世界卫生组织女性生殖器肿瘤分类中。它们具有相似的形态和免疫表型,并表现出与宫颈中肾腺癌相似的分子畸变。关于它们是中肾起源还是缪勒起源存在争议。我们描述了 5 例宫外中肾样增生(4 例卵巢,1 例卵巢外)的临床、病理学、免疫组化和分子特征,均具有新的和迄今未报道的特征。这些包括卵巢外子宫内膜异位症中 MLA 的起源,卵巢 MLA 与高级别浆液性癌、混合生殖细胞肿瘤和成熟畸胎瘤的关联,以及表现出中肾分化的交界性卵巢子宫内膜样肿瘤。其中四个病例表现出 KRAS 变体,3 个也表现出 PIK3CA 变体。在报告这些病例时,我们扩展了已发表的与 MLA 相关的肿瘤类型,并首次报告了表现出中肾分化的临界肿瘤。我们展示了分子检测在帮助确认中肾样病变和确定不同肿瘤成分之间关系方面的价值。在某些情况下,我们提供了缪勒起源的进一步证据,而不是真正的中肾起源。我们还推测,在与生殖细胞肿瘤相关的 2 例病例中,MLA 起源于生殖细胞肿瘤。我们扩展了已发表的与 MLA 相关的肿瘤类型,并首次报告了表现出中肾分化的临界肿瘤。我们展示了分子检测在帮助确认中肾样病变和确定不同肿瘤成分之间关系方面的价值。在某些情况下,我们提供了缪勒起源的进一步证据,而不是真正的中肾起源。我们还推测,在与生殖细胞肿瘤相关的 2 例病例中,MLA 起源于生殖细胞肿瘤。我们扩展了已发表的与 MLA 相关的肿瘤类型,并首次报告了表现出中肾分化的临界肿瘤。我们展示了分子检测在帮助确认中肾样病变和确定不同肿瘤成分之间关系方面的价值。在某些情况下,我们提供了缪勒起源的进一步证据,而不是真正的中肾起源。我们还推测,在与生殖细胞肿瘤相关的 2 例病例中,MLA 起源于生殖细胞肿瘤。在某些情况下,我们提供了缪勒起源的进一步证据,而不是真正的中肾起源。我们还推测,在与生殖细胞肿瘤相关的 2 例病例中,MLA 起源于生殖细胞肿瘤。在某些情况下,我们提供了缪勒起源的进一步证据,而不是真正的中肾起源。我们还推测,在与生殖细胞肿瘤相关的 2 例病例中,MLA 起源于生殖细胞肿瘤。
更新日期:2021-07-01
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