Case 63 - Discussion

Uploaded: 2007-07-11, Updated: 2007-07-11

 

 

 

Mesonephric remnant of the cervix

 

Mesonephric (wolffian) remnants are the vestigial elements of the mesonephric ducts. In men, the mesonephric ducts develop into the efferent ducts of the testis, epididymis, vasa deferentia, seminal vesicles, and ejaculatory ducts. In women, the ducts usually regress but can persist as remnants in the broad ligament, cervix, and vagina. Mesonephric remnants are present in up to 22% of cervices, usually in the lateral wall.

Mesonephric remnants consist of small cysts and/or tubules lined by bland cuboidal or low columnar nonciliated epithelium. The cytoplasm may appear clear or eosinophilic but does not contain cytoplasmic mucin (in contrast to endocervical epithelium) or glycogen. Characteristically, a densely eosinophilic, PAS-positive, luminal secretion is present.

 

Mesonephric hyperplasia has been divided into three categories:

  1. Lobular mesonephric hyperplasia: proliferation of loosely organized, variably sized, mesonephric tubules predominantly arranged in lobules.

  2. Diffuse mesonephric hyperplasia: no lobular pattern is apparent. The diffuse form of mesonephric hyperplasia
    thus may be the most diagnostically challenging, because it appears less organized and can extend deeply into the
    cervical wall, mimicking a well-differentiated adenocarcinoma.

  3. Pure mesonephric ductal hyperplasia: the least common subtype of the mesonephric hyperplasia, characterized by a prominent duct lined by hyperplastic appearing epithelium with papillary tufting,

Differential diagnosis of mesonephric hyperplasia

  • Mesonephric carcinoma: exceedingly rare, may co-existent with mesonephric hyperplasia. Mesonephric carcinoma is usually associated with a visible gross abnormality.Mesonephric carcinoma exhibits a greater degree of glandular crowding (“back-to-back” glandular growth), an irregular, disorderly growth pattern, greater nuclear atypia, prominent mitotic activity, and often an associated stromal reaction.

  • Endocervical adenocarcinoma: more irregularly shaped and sized glands that are lined by mucinous epithelium. Desmoplastic stromal response, nuclear atypia, and mitotic activity.

  • Clear-cell carcinoma, tubulocystic variant: the cells lining the tubules in mesonephric hyperplasia are bland and lack the abundant glycogen-rich clear cytoplasm. clear-cell carcinoma has more prominent nuclear atypia. In addition, areas of solid growth and hobnail cells, features typical of clear-cell carcinoma, are not seen in mesonephric hyperplasia.

 

Reference:

  • Marisa R. Nucci, M.D. Symposium Part III: Tumor-like Glandular Lesions of the Uterine Cervix. International Journal of Gynecological Pathology. 21:347–359,