Endometrial Mesonephric- Like Adenocarcinmona: A Case Report of an Aggressive Rare Endometrial Cancer - Abstract
Background: Endometrial mesonephric adenocarcinoma is a rare aggressive tumor of the female genital tract, which originates from mesonephric duct remnants. Its diagnosis is
pathologically challenging, because it may exhibit a mixture of morphological patterns that complicates the differential diagnosis.
Case: A 56-year-old female para 2, gravida 2, presented with multiple episodes of vaginal bleeding. Treated with 52 mg levonorgestrel-releasing intrauterine system. Followup
endometrial sampling every 6 months converted to normal, inactive endometrium at one year. After more than 4 years of amenorrhea, she presented with multiple episodes of
vaginal bleeding again. A repeat endometrial biopsy showed atypical glandular proliferation, cannot exclude endometrioid adenocarcinoma. She underwent a total laparoscopic
hysterectomy, bilateral salpingo-oophorectomy. The final pathology of the uterine specimen was reported as a mesonephric like adenocarcinoma, an unusual histological type of
uterine neoplasia.
Conclusion: Mesonephric-like adenocarcinomas are considered high-grade carcinomas, even though they have a misleadingly low-grade morphology. Endometrial biopsy
can be mis-leading such that it can delay diagnosis. This case demonstrates that reassuring endometrial sampling may not be sufficient to evaluate these unusual tumours and that
progesterone therapy may not be sufficient to manage or prevent progression of these rare, high-grade tumours. Previous literature describes these tumors as having a high risk
of recurrence and a high tendency for metastasis, especially to the lung and brain. A multidisciplinary team is necessary to optimize management. Unfortunately, treatment options
are limited and the best therapeutic strategy is yet to be determined. Further research on the pathogenesis should help better understand this specific subset of endometrial cancer.