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Mixed Mesonephric-like Adenocarcinoma, Clear Cell Carcinoma, and Endometrioid Carcinoma Arising from an Endometriotic Cyst.

  • Nagase, Shunsuke1
  • Saeki, Harumi1
  • Ura, Ayako1
  • Terao, Yasuhisa2
  • Matsumoto, Toshiharu3
  • Yao, Takashi1
  • 1 Department of Human Pathology, Juntendo University Faculty of Medicine, Tokyo, Japan. , (Japan)
  • 2 Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan. , (Japan)
  • 3 Department of Diagnostic Pathology, Juntendo Nerima Hospital Faculty of Medicine, Tokyo, Japan. , (Japan)
Published Article
International journal of surgical pathology
Publication Date
Nov 22, 2023
DOI: 10.1177/10668969231213390
PMID: 37994045


Mesonephric-like adenocarcinoma is a rare neoplasm of the uterine corpus and ovary. Unlike prototypical mesonephric adenocarcinoma of the uterine cervix, which is considered of Wolffian origin, recent evidence suggests that mesonephric-like adenocarcinoma is a Mullerian tumor associated with endometriosis. We report here on a 48-year-old woman with a mixed carcinoma of the ovary that consisted of mesonephric-like adenocarcinoma, clear cell carcinoma, and endometrioid carcinoma, arising from an endometriotic cyst. The mesonephric-like adenocarcinoma consisted of cuboidal cells with vesicular nuclei presenting with a tubular, ductal, papillary, and solid architecture forming nodules. Each component showed distinct immunophenotypes that were consistent with their morphology. The mesonephric-like adenocarcinoma showed diffuse positive staining for paired box 8 and GATA binding protein 3, and negative staining for estrogen and progesterone receptors. A p53 stain exhibited wild-type immunoreactivity. A complete loss of AT-rich interactive domain-containing protein 1A (ARID1A) expression was suggestive of an ARID1A mutation. Manual macrodissection and Sanger sequencing revealed identical KRAS and PIK3CA mutations in all three components. To the best of our knowledge, this is the first report of mesonephric-like adenocarcinoma combined with a clear cell carcinoma and endometrioid carcinoma, which supports the hypothesis that mesonephric-like adenocarcinoma is an endometriosis-associated neoplasm. The report also highlights a potential pitfall in diagnosing mesonephric-like adenocarcinoma combined with clear cell carcinoma.

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