[Adenocarcinomas with mesonephric features in gynecologic tract: a clinicopathological analysis of seven cases]

Objective: To investigate and compare the histologic characteristics of adenocarcinomas with mesonephric features located in different parts of the gynecologic tract. Methods: Two cases of mesonephric adenocarcinomas (MA) of the cervix and 5 cases of mesonephric-like adenocarcinomas (MLA) of the uterus and ovary were collected in Women's Hospital, School of Medicine, Zhejiang University from January 2018 to October 2020. Hematoxylin-eosin staining, immunohistochemistry and KRAS mutation testing were performed together with review of literature. Results: MA of the cervix as well as MLA of the uterus and ovary had similar morphologic features, showing an admixture of glandular, tubular, papillary and solid growth patterns. However, both MA cases were located in cervical stroma, which demonstrated residual mesonephric ducts present at the periphery. All four uterine MLA cases extensively involved the endometrium and myometrium. The ovarian MLA case was associated with endometriosis. No residual mesonephric ducts were present in the MLA cases. Immunohistochemically, GATA3 was positive in all seven MA/MLA cases. TTF1 was expressed only in 4/5 MLA cases. ER and PR were negative and p53 was wild-type in all cases. KRAS mutation was detected in all five cases. During the 6-32 months of follow-up, one patient developed recurrence and the others were tumor-free. Conclusions: In the gynecologic tract, both MA in cervix and MLA in uterus and ovary have similar morphologic features, immunohistochemical expression and KRAS mutation. However, distinct from MA that originates from mesonephric remnant, MLA is closely related to Mullerian epithelium.

[Clinicopathologic features of solitary fibrous tumor in urogenital system]

OBJECTIVE

To study the clinicopathologic features and differential diagnosis of solitary fibrous tumor (SFT) in the urogenital system.

METHODS

The clinical data and pathologic characteristics of eight cases of SFT in the urogenital system were analyzed, and the relevant literature was reviewed.

RESULTS

The cohort included six male and two female patients, with age of onset ranging from 25 to 80 years. Five occurred in the kidney (three in the right kidney), one case each occurred in the bladder, the prostate and the spermatic cord. Most patients showed no obvious clinical symptoms or only had low back pain and swelling. The diameter of the tumor was ranged from 2.5 to 11.8 cm (median 5.2 cm). Microscopy showed at low magnification, the tumor cells were spindle-shaped and arranged in bundles or helicoid pattern. The regional mesenchymal fibroblasts showed hyperplasia, with obvious collagenization and formed hemangiopericytoma-like structure. One case showed increased mitotic figures (>5 cells/10 HPF) and focal necrosis. By immunohistochemistry, the tumor cells were positive for CD34 and STAT6 in all eight cases, CD99 and vimentin in six cases, bcl-2 in four cases and SMA in one case. All seven cases with follow-up did not show any tumor recurrence or metastasis.

CONCLUSIONS

SFT is rare in the urogenital system and most patients show good prognosis. SFT expresses CD34 and STAT6 and needs to be distinguished from other spindle cell tumors.