Mesonephric and Mesonephric-like Adenocarcinomas of the Gynecologic Tract: A Case Series and a Review of the Literature

We sought to present and describe all cases of mesonephric adenocarcinoma (MNAC) and mesonephric-like adenocarcinomas (MLAs) at our institution. These cancers are rare, morphologically similar tumors of the female reproductive tract. In this case series, we present 13 new cases of MNAC/MLA that were identified at St. Luke’s University Health Network from 2016 to 2024. Demographics, clinical characteristics, and pathologic findings were collected from chart review. There were 6 uterine, 5 ovarian, and 2 cervical MNAC/MLAs. At presentation, more than half of the patients presented at early stages with 7, 2, 3, and 1 diagnosed at stages I, II, III, and IV, respectively. All patients underwent upfront surgical resection and were recommended adjuvant therapy. One patient declined adjuvant treatment. At the time of writing, 9 of 13 patients have completed treatment and have no evidence of disease, 1 is alive with disease, 1 is currently undergoing treatment, and 2 died of disease. Median overall survival (OS) was 15 mo (95% CI: 2.2–27.8 mo). Current literature regarding MNACs/MLAs suggests an overall poor prognosis, with the majority presenting at advanced stages. This case series describes patients diagnosed with early-stage disease and reports on their histopathology, treatment regimens, and clinical outcomes. The majority of these patients are without recurrence after upfront treatment. Continued surveillance of these patients to determine long-term outcomes is necessary to further elucidate overall prognosis.