Mesonephric remnant with seminal vesicle-like appearance in the cervix

Testosterone-induced Seminal Vesicle-like Differentiation in Cervical Mesonephric Duct Remnants in a Female to Male Transgender Patient

Pure ductal-type mesonephric remnants in the uterine cervix are rare. We report an unusual case in a 31-yr-old of cervical mesonephric remnants of predominantly ductal type exhibiting seminal vesicle-like differentiation in a female-to-male transgender patient receiving long-term testosterone therapy. To the best of our knowledge, this phenomenon has not been previously reported. The impact of testosterone on the female genital tract is likely to be encountered more frequently due to increasing rates of gender-affirming surgery, including long-term androgen use. Awareness of the morphologic features is important as such changes may be misinterpreted as premalignant or malignant lesions. In reporting this unusual case, we briefly review lesions derived from cervical mesonephric remnants and testosterone-associated changes in the female genital tract.

Mesonephric proliferations of the female genital tract

The mesonephric (Wolffian) duct regresses in females during embryological development. Remnants of this duct may persist typically along the lateral walls of the cervix, vagina, adnexa, and uterine corpus. These mesonephric epithelia may expand into hyperplastic proliferations and rarely form neoplasms. The spectrum of morphology, immunophenotype, clinical presentation, and molecular characteristics of mesonephric lesions is reviewed, with attention to distinction from entities in the differential diagnosis.