女性生殖道中肾腺癌临床病理及分子特征分析OACSTPCD

Objective:To investigate the clinicopathological and molecular features of mesonephric adenocarcinoma of the gynecologic tract.Methods:Four cases of cervical meso-nephric adenocarcinoma and 1 case of vaginal mesonephric adenocarcinoma diagnosed between January 2014 and December 2023 were collected and retrospectively analyzed.Results:The av-erage age at diagnosis was 55(range 49 to 63 years).The main clinical presentation was abnor-mal vaginal bleeding.All 4 cases of cervical mesonephric adenocarcinoma were misdiagnosed before surgery.All patients underwent radical hysterectomy + bilateral salpingo-oophorectomy + pelvic lymphadenectomy±para-aortic lymphadenectomy,with neoadjuvant chemotherapy and/or platinum-based chemotherapy±radiation therapy±antiangiogenic treatment.4 cases of cer-vical mesonephric adenocarcinoma were diagnosed as FIGO stage Ⅰb1 to Ⅱb,and the vaginal mesonephric adenocarcinoma was diagnosed as stage Ⅲ.The cervical mesonephric adenocarci-noma cases were located in the cervical stroma,which demonstrated residual mesonephric ducts presented at the periphery.The histology staining results showed that all cases were positive for PAX8,GATA3,and CD10,and negative for TTF-1,ER,and PR,meanwhile four were TP53 wild type.According to NGS results,KRAS mutations were detected in 2 cases.All patients were fol-lowed for a mean period of 51 months(range 18～115).One patient with vaginal mesonephric adenocarcinoma developed lung metastasis at 13 months follow-up.Conclusion:Mesonephric adenocarcinoma is a rare tumor of the female genital tract,which originates from mesonephric duct remnants.Mesonephric adenocarcinoma is prone to misdiagnosed,and its diagnosis can be clarified with the help of immunohistochemical features.KRAS/NRAS mutation appear to be highly prevalent in mesonephric adenocarcinoma,and therapeutics that target this pathway are worthy of further study.