Clinicopathology and prognosis of mesonephric carcinomas

Abstract Background: Mesonephric adenocarcinoma (MNA) and Mesonephric-like adenocarcinoma (MLA) are rare malignant tumors of the female genital tract with extremely similar histopathological, immunohistochemical, and molecular characteristics. Differential diagnosis is therefore challenging, and experience in treatment and prognosis is lacking.Methods: We collected clinicopathological features and immunohistochemical and follow-up information from 2 patients with mesonephric carcinomas (1 case of MNA and 1 case of MLA). A total of 139 cases of MNA and MLA were obtained from PubMed and CNKI through keyword searches. The clinicopathological features and prognostic information of 141 cases of mesonephric carcinomas werecompared and analyzed. This detailed review of the literature provides a comprehensive overview of currently knownmesonephric carcinomas.Results: The median ages of MNA and MLA patients were 51 and 59 years, respectively. The most common clinical symptoms of both patients were irregular vaginal bleeding. Microscopically, these tumor cells are mostly arranged in mixed patterns, such as tubular, glandular and glomeruloid patterns. Tubular and glandular patterns are the most frequently described. MNA is characterized by mesonephric remnants adjacent to tumor tissue. Immunohistochemical staining is positive GATA3, PAX-8 and CD10 expression and negative ER, PR and P16 expression. TTF-1 expression is most common in MLA. The most common genetic change is KRAS gene mutation. The five-year survival rates of MNA and MLA are 73.5% and 68.5%, with recurrence rates of 33% and 58% and median times to recurrence of 20 and 12 months, respectively. Age affects the survival prognosis of MNA and MLA (P=0.04, P<0.01), and there is a significant difference in the DFS K-M survival curve between MNA and MLA (P<0.01).Conclusions: The typical microscopic morphology and expression of immunomarkers support the diagnosis of MNA and MLA. Microscopically, mesonephric remnants adjacent to tumor tissue and immunohistochemical marker TTF-1 expression are key for the differential diagnosis of MNA and MLA. The recurrence and metastasis rates of MLA are much higher than those of MNA, and the prognosis is poor. Age is an important factor influencing the survival and prognosis of MNA and MLA. The most effective treatment for mesonephroid tumors remains to be further elucidated.