Mesonephric-like adenocarcinoma of the ovary with co-existent endometriosis: A case report and review of the literature

Highlights

• Mesonephric-like adenocarcinomas (MLA) of the ovary are rare, require differentiation from other histiotypes.

• True histiogenesis of MLA of ovary remains debated, possibly arise from mullerian lesions of the ovary.

• MLA of ovary have differing genotypes from true mesonephric carcinomas of the cervix.

• Case described reflects further evidence for mullerian origin of MLA of ovary, with endometriosis in affected ovary.

• MLA of ovary can act aggressively, case described recurred and responded only partially to chemotherapy.

Abstract

Introduction

Mesonephric-like adenocarcinoma (MLA) is a rare malignant gynecologic neoplasm occurring in the uterine corpus and ovary. The morphological and immunohistochemical characteristics of MLA closely resemble that of cervical mesonephric adenocarcinomas, but whether they share a common histogenesis remains unclear. Two main theories for histogenesis of MLAs include the origination of these neoplasms from mesonephric remnants, as is the case for cervical mesonephric adenocarcinoma, versus the differentiation along a mesonephric pathway from Mullerian lesions.

Case

A 67-year-old presented after a right salpingo-oophorectomy for a complex ovarian mass revealed a mesonephric-like adenocarcinoma of the ovary and endometriosis. She underwent a total abdominal hysterectomy, pelvic lymphadenectomy, and infra-colic omentectomy, and diagnosed with Stage IA mesonephric-like adenocarcinoma of the ovary. At 18 months post-operatively, the patient developed flank and abdominal pain and was found to have multiple sites of recurrent disease. She was referred to medical oncology for chemotherapy as she was not a candidate for surgical cytoreduction.

Discussion

This case demonstrates the aggressive nature of ovarian MLA and the need for a multidisciplinary approach when determining the treatment. In addition, this case provides further evidence to support the theory that at least a subset of MLAs arises from a Mullerian lesion which then differentiates down a mesonephric pathway.