Mesonephric hyperplasia can cause abnormal cervical smears: report of three cases with review of literature

Cytological features of mesonephric-like adenocarcinoma of the uterine corpus

BACKGROUND

Although several studies have documented the histological features of uterine mesonephric-like adenocarcinoma (MLA), its cytological features have been rarely reported.

METHODS

We searched for histologically confirmed uterine MLA cases in the pathology archives of three institutions between 2010 and 2021. All available cytology slides were examined to identify the cytological features of uterine MLA.

RESULTS

We included 16 patients with uterine MLA and reviewed the slides obtained from 21 cytology samples. Samples were obtained from the cervicovagina (9/21, 42.9%), peritoneal washing (8/21, 38.1%), pleural effusion (2/21, 9.5%), and transbronchial needle aspiration of mediastinal lymph node (2/21, 9.5%). Preparation methods included ThinPrep (11/21, 52.4%), SurePath (8/21, 38.1%), and conventional smear (2/21, 9.5%). Regardless of the sampling site and preparation method, cytology samples displayed tight three-dimensional cellular clusters showing monotonous, small-to-medium-sized, round, hyperchromatic nuclei, indistinct nucleoli, scant cytoplasm, and high nuclear-to-cytoplasmic ratio. Approximately half of the samples (10/21, 47.6%) showed hyaline-like globules. Mitotic figures (7/21, 33.3%) and apoptotic bodies (13/21, 61.9%) were also observed. No tumor diathesis or nuclear feathering was identified.

CONCLUSIONS

Irrespective of sampling site and preparation method, the majority of uterine MLA cases showed the following cytological features: tight three-dimensional cellular clusters showing small-to-medium-sized, round, hyperchromatic nuclei with indistinct nucleoli and high nuclear-to-cytoplasm ratio. In case a cytology sample suspicious of a glandular lesion displays these cytological features, which are distinct from those of endocervical adenocarcinoma, uterine MLA should be included in the differential diagnosis.

Mesonephric adenocarcinoma of the uterine cervix: a case report with immunohistochemical and ultrastructural studies

A very rare case of mesonephric adenocarcinoma with lobular mesonephric hyperplasia in the uterine cervix of a 46-year-old female is presented. The lesion was a 4 cm, exophytic, almost circumferential, whitish yellow, friable mass in the uterine cervix. Microscopically, the tumor was composed predominantly of atypical round to polygonal cells arranged in a ductal, tubular, or papillary pattern. The tumor involved the entire cervix with varying depths of penetration. Lobular mesonephric hyperplasia was also observed in the lateral cervical wall and adjacent to the tumor. Immunohistochemically, the tumor was positive for CAM5.2, CK7, epithelial membrane antigen, calretinin, and chromogranin A, and was negative for vimentin, carcinoembryonic antigen, estrogen and progesterone receptors, and CD10. An ultrastructural analysis showed telolysomes, which were characteristic features of mesonephric epithelium. The patient was alive without disease at 4 months after surgery.