Synchronous ovarian and uterine mesonephric-like carcinoma that potentially arose from endometrioid adenofibroma: A case report.

Mesonephric-like carcinoma histologically resembles mesonephric adenocarcinoma (MA) of the cervix. MA arises from mesonephric duct remnants. However, the origin of mesonephric-like carcinoma is not extensively studied because of its rarity. Here, we present a case of synchronous ovarian and uterine mesonephric-like carcinoma that potentially arose from endometrioid adenofibroma. A 69-year-old woman presented with an abdominal mass with no genital bleeding. She underwent simple total abdominal hysterectomy and bilateral adnexal resection. Histological and immunohistochemical analyses were consistent with mesonephric-like carcinoma involving both ovaries and the uterus. Endometrioid adenofibroma was present in both ovaries, while adenomyosis was observed in the uterus. The glandular duct of the endometrioid adenofibroma in the right ovary had areas suggestive of precursor lesions of mesonephric-like carcinoma. All tumors exhibited the KRAS G12D mutation. These findings suggest that the origin of the mesonephric-like carcinoma was the Müllerian duct, and that the ovarian and uterine tumors were monoclonal.

Characterization of patients that can continue conservative treatment for adenomyosis.

BACKGROUND: Historically, hysterectomy has been the radical treatment for adenomyosis. Although, some patients may not want to have their uterus removed, patients often have to no choice but to request hysterectomy during conservative treatment. The factors necessitating these hysterectomies remain unknown. The purpose of this study was to determine which patients can continue conservative treatment for adenomyosis. METHODS: We selected women diagnosed with adenomyosis and provided with conservative treatment at the Kindai University Hospital and Osaka Red Cross Hospital in Osaka Japan from 2008 to 2017. Age at diagnosis, parity, uterine size, subtype of adenomyosis, type of conservative treatment, and timing of hysterectomy for cases with difficulty continuing conservative treatment were examined retrospectively. RESULTS: A total of 885 patients were diagnosed with adenomyosis, and 124 started conservative treatment. Conservative treatment was continued in 96 patients (77.4%) and hysterectomy was required in 28 patients (22.6%). The cumulative hysterectomy rate was 32.4%, and all women had hysterectomy within 63 months. In the classification tree, 82% (23/28) of women aged 46 years or younger were able to continue conservative treatment when parity was zero or one. In those with parity two and over, 95% (20/21) of those aged 39 years and older had hysterectomy. CONCLUSIONS: Patients who continue conservative treatment for approximately 5 years are more likely to have successful preservation of the uterus. Multiparity and higher age at diagnosis are factors that contribute to hysterectomy after conservative treatment. Parity and age at diagnosis may be stratifying factors in future clinical trials of hormone therapy.

[A retrospective study of advanced ovarian cancer in our ward].

OBJECTIVE: To evaluate the efficacy of primary treatment for ovarian cancer from overall survival and progression-free survival. PATIENTS AND METHODS: A total of 28 patients with epithelial ovarian cancer in stages III and IV who were primarily treated in our ward from 1993 were examined retrospectively. The Kaplan-Meier method and Harrington-Fleming test were carried out for the cumulative survival rate and analysis. RESULTS: There were significant differences in the progression-free survival rate depending on whether or not optimal debulking was possible through primary treatment (p = 0.0128) and whether the histological diagnosis was serous adenocarcinoma (p = 0.038). In the serous adenocarcinoma group, the periods of both overall survival and progression-free survival were longer in treatment with taxanes and platinum than by other regimens, but in the endometrioid adenocarcinoma group, the period of progression-free survival was very short. CONCLUSIONS: Optimal debulking through primary treatment is critical in advanced ovarian cancer. Therapy with taxanes and platinum is efficacious for serous adenocarcinoma. The chemo-sensitivity of endometrioid adenocarcinoma is high, but the chemotherapeutic effect is only temporary.