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1.
Anticancer Res ; 41(9): 4587-4601, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475087

RESUMO

BACKGROUND/AIM: Ovarian endometrioid carcinoma (EC) and high-grade serous carcinoma (HGSC) may exhibit various growth patterns and mimic mesonephric-like adenocarcinoma (MLA). We investigated the clinicopathological and molecular features of ovarian carcinomas with mesonephric-like differentiation (MLD). PATIENTS AND METHODS: We analyzed the electronic medical records and pathology slides of two EC-MLD and three HGSC-MLD patients, and conducted immunostaining and targeted sequencing of their samples. RESULTS: All cases showed architectural diversity, compactly aggregated small tubules and ducts, and eosinophilic intraluminal secretions, indicating the possibility of an ovarian MLA. However, the following histological and immunophenotypical features confirmed the diagnoses of EC-MLD and HGSC-MLD: squamous, tubal, and sertoliform differentiation; serous tubal intraepithelial carcinoma; solid, endometrioid, transitional (SET) feature; solid, transitional, endometrioid, mucinous-like (STEM) feature; diffuse expression of hormone receptors and Wilms tumor 1; mutant p53 immunostaining pattern; and wild-type v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog gene. CONCLUSION: A subset of ovarian ECs and HGSCs can display MLD and mimic an MLA. A thorough histological examination combined with ancillary tests is crucial to differentiate between these ovarian neoplastic entities.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma Endometrioide/patologia , Cistadenocarcinoma Seroso/patologia , Neoplasias Ovarianas/patologia , Ductos Mesonéfricos/patologia , Adulto , Carcinoma Endometrioide/metabolismo , Cistadenocarcinoma Seroso/metabolismo , Diagnóstico Diferencial , Registros Eletrônicos de Saúde , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Ovarianas/metabolismo , Proteínas Proto-Oncogênicas p21(ras)/metabolismo , Estudos Retrospectivos , Proteína Supressora de Tumor p53/metabolismo , Proteínas WT1/metabolismo , Ductos Mesonéfricos/metabolismo
2.
Zhonghua Bing Li Xue Za Zhi ; 50(7): 791-795, 2021 Jul 08.
Artigo em Chinês | MEDLINE | ID: mdl-34405616

RESUMO

Objective: To investigate and compare the histologic characteristics of adenocarcinomas with mesonephric features located in different parts of the gynecologic tract. Methods: Two cases of mesonephric adenocarcinomas (MA) of the cervix and 5 cases of mesonephric-like adenocarcinomas (MLA) of the uterus and ovary were collected in Women's Hospital, School of Medicine, Zhejiang University from January 2018 to October 2020. Hematoxylin-eosin staining, immunohistochemistry and KRAS mutation testing were performed together with review of literature. Results: MA of the cervix as well as MLA of the uterus and ovary had similar morphologic features, showing an admixture of glandular, tubular, papillary and solid growth patterns. However, both MA cases were located in cervical stroma, which demonstrated residual mesonephric ducts present at the periphery. All four uterine MLA cases extensively involved the endometrium and myometrium. The ovarian MLA case was associated with endometriosis. No residual mesonephric ducts were present in the MLA cases. Immunohistochemically, GATA3 was positive in all seven MA/MLA cases. TTF1 was expressed only in 4/5 MLA cases. ER and PR were negative and p53 was wild-type in all cases. KRAS mutation was detected in all five cases. During the 6-32 months of follow-up, one patient developed recurrence and the others were tumor-free. Conclusions: In the gynecologic tract, both MA in cervix and MLA in uterus and ovary have similar morphologic features, immunohistochemical expression and KRAS mutation. However, distinct from MA that originates from mesonephric remnant, MLA is closely related to Mullerian epithelium.


Assuntos
Adenocarcinoma , Neoplasias Uterinas , Adenocarcinoma/genética , Biomarcadores Tumorais , Feminino , Humanos , Imuno-Histoquímica , Neoplasias Uterinas/genética , Ductos Mesonéfricos
3.
Anticancer Res ; 41(5): 2719-2726, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952503

RESUMO

BACKGROUND/AIM: We present a case of uterine dedifferentiated mesonephric-like adenocarcinoma (MLA). CASE REPORT: A 54-year-old woman underwent total hysterectomy for a uterine mass under the impression of a uterine sarcoma. Histologically, MLA exhibited various growth patterns including tubular and glandular architecture. Undifferentiated carcinoma (UC) displayed discohesive tumor cells without any obvious architecture. Immunohistochemically, UC was positive for epithelial markers in very few scattered tumor cells. MLA exhibited the wild-type p53 expression pattern, whereas UC showed a uniform and strong p53 immunoreactivity. Targeted sequencing analysis revealed an identical Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation in both components. A pathogenic missense tumor protein 53 (TP53) mutation was detected in UC, but not in MLA. CONCLUSION: The mutant p53 expression pattern exclusively detected in UC was concordant with the presence of missense TP53 mutation. Our observations suggested that TP53 mutation is associated with the possible transformation from MLA to UC.


Assuntos
Adenocarcinoma/diagnóstico , Carcinoma/diagnóstico , Sarcoma/diagnóstico , Doenças Uterinas/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Carcinoma/genética , Carcinoma/patologia , Carcinoma/cirurgia , Desdiferenciação Celular/genética , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Sarcoma/genética , Sarcoma/patologia , Sarcoma/cirurgia , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia , Ductos Mesonéfricos/diagnóstico por imagem , Ductos Mesonéfricos/patologia , Ductos Mesonéfricos/cirurgia
4.
Development ; 148(18)2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-33795229

RESUMO

During development of the mouse urogenital complex, the gonads undergo changes in three-dimensional structure, body position and spatial relationship with the mesonephric ducts, kidneys and adrenals. The complexity of genital ridge development obscures potential connections between morphogenesis and gonadal sex determination. To characterize the morphogenic processes implicated in regulating gonad shape and fate, we used whole-embryo tissue clearing and light sheet microscopy to assemble a time course of gonad development in native form and context. Analysis revealed that gonad morphology is determined through anterior-to-posterior patterns as well as increased rates of growth, rotation and separation in the central domain that may contribute to regionalization of the gonad. We report a close alignment of gonad and mesonephric duct movements as well as delayed duct development in a gonad dysgenesis mutant, which together support a mechanical dependency linking gonad and mesonephric duct morphogenesis.


Assuntos
Gônadas/fisiologia , Morfogênese/fisiologia , Ductos Mesonéfricos/fisiologia , Animais , Embrião de Mamíferos/fisiologia , Feminino , Idade Gestacional , Rim/fisiologia , Masculino , Mesonefro/fisiologia , Camundongos , Camundongos Endogâmicos C57BL , Diferenciação Sexual/fisiologia
5.
Pathol Res Pract ; 220: 153388, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33647867

RESUMO

Mesonephric remnants are embryonic vestiges of the mesonephric (Wolffian) ducts which regress during normal development. These remnants have been uncommonly reported in the female and male reproductive tract as a spectrum of morphologic lesions that can be misdiagnosed as carcinoma. One case of mesonephric remnant hyperplasia of the jejunal mesentery incidentally found in a 47-year-old man is herein reported. This is the first description of mesonephric hyperplasia arisen in the mesentery. The presence of ducts, tubules, and cysts lined by bland, epithelial, cuboidal cells with scant cytoplasm, and diffuse pseudoinfiltrative growth pattern can raise the possibility of neoplasia. Immunohistochemically, mesonephric epithelia have a characteristic staining. CD10 highlights the apical-luminal aspect of the cells. Besides, intense reactivity is showed for high-molecular-weight cytokeratin (CK), CK7, bcl2, and vimentin. The main differential diagnosis includes mesothelial hyperplasia, epithelial mesothelioma, well-differentiated neuroendocrine tumor, and infiltration due to acinar adenocarcinoma of the prostate. However, a detailed microscopic study with the aid of immunohistochemistry helps separate mesonephric remnants from malignant processes. The mesonephric hyperplasia of the mesentery we have reported adds to the spectrum of mesonephric remnants a new location. Familiarity with this lesion is indispensable to avoid overdiagnosis.


Assuntos
Achados Incidentais , Jejuno/patologia , Mesentério/patologia , Mesonefro/metabolismo , Ductos Mesonéfricos/patologia , Biomarcadores/análise , Biópsia , Diagnóstico Diferencial , Humanos , Hiperplasia , Imuno-Histoquímica , Jejuno/química , Jejuno/cirurgia , Masculino , Mesentério/química , Mesentério/cirurgia , Mesonefro/química , Mesonefro/cirurgia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Ductos Mesonéfricos/química , Ductos Mesonéfricos/cirurgia
6.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 48(1): 41-43, ene.-mar. 2021. ilus
Artigo em Espanhol | IBECS | ID: ibc-201990

RESUMO

La persistencia de restos derivados del mesonefros suele presentarse en las paredes laterales del cérvix de forma frecuente. En cambio, la evolución hacia una hiperplasia mesonéfrica o un carcinoma mesonéfrico es muy poco frecuente. Presentamos a una paciente de 50 años, intervenida de histerectomía por útero miomatoso, en cuya pieza quirúrgica se describe una hiperplasia mesonéfrica difusa. La presencia de restos procedentes del mesonefros o hiperplasia, constituyen en casi la totalidad de las ocasiones un hallazgo benigno que no precisa tratamiento. Es necesario conocer las características de este tipo de lesiones derivadas del mesonefros, para evitar tratamientos innecesarios


The persistence of mesonephric remnants is often present on the side walls of the cervix. However, the evolution towards mesonephric hyperplasia or mesonephric carcinoma is very rare. The case is presented of a 50-year-old female patient, who underwent hysterectomy for myomatous uterus, and in which surgical specimen was described a diffuse mesonephric hyperplasia. The presence of remains from mesonephros or hyperplasia is almost always a benign finding that does not require treatment. It is necessary to know the characteristics of this type of lesion derived from mesonephros, in order to avoid unnecessary treatments


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Ductos Mesonéfricos/patologia , Mesonefro/patologia , Histerectomia Vaginal/métodos , Ductos Mesonéfricos/diagnóstico por imagem , Vimentina/análise , Biomarcadores Tumorais/análise
7.
Am J Hum Genet ; 108(2): 337-345, 2021 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-33434492

RESUMO

Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) is associated with congenital absence of the uterus, cervix, and the upper part of the vagina; it is a sex-limited trait. Disrupted development of the Müllerian ducts (MD)/Wölffian ducts (WD) through multifactorial mechanisms has been proposed to underlie MRKHS. In this study, exome sequencing (ES) was performed on a Chinese discovery cohort (442 affected subjects and 941 female control subjects) and a replication MRKHS cohort (150 affected subjects of mixed ethnicity from North America, South America, and Europe). Phenotypic follow-up of the female reproductive system was performed on an additional cohort of PAX8-associated congenital hypothyroidism (CH) (n = 5, Chinese). By analyzing 19 candidate genes essential for MD/WD development, we identified 12 likely gene-disrupting (LGD) variants in 7 genes: PAX8 (n = 4), BMP4 (n = 2), BMP7 (n = 2), TBX6 (n = 1), HOXA10 (n = 1), EMX2 (n = 1), and WNT9B (n = 1), while LGD variants in these genes were not detected in control samples (p = 1.27E-06). Interestingly, a sex-limited penetrance with paternal inheritance was observed in multiple families. One additional PAX8 LGD variant from the replication cohort and two missense variants from both cohorts were revealed to cause loss-of-function of the protein. From the PAX8-associated CH cohort, we identified one individual presenting a syndromic condition characterized by CH and MRKHS (CH-MRKHS). Our study demonstrates the comprehensive utilization of knowledge from developmental biology toward elucidating genetic perturbations, i.e., rare pathogenic alleles involving the same loci, contributing to human birth defects.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/genética , Anormalidades Congênitas/genética , Ductos Paramesonéfricos/anormalidades , Ductos Paramesonéfricos/crescimento & desenvolvimento , Mutação , Ductos Mesonéfricos/crescimento & desenvolvimento , Adulto , Proteína Morfogenética Óssea 4/genética , Proteína Morfogenética Óssea 7/genética , Códon sem Sentido , Feminino , Estudos de Associação Genética , Pleiotropia Genética , Proteínas Homeobox A10/genética , Proteínas de Homeodomínio/genética , Humanos , Fator de Transcrição PAX8/genética , Herança Paterna , Penetrância , Proteínas com Domínio T/genética , Fatores de Transcrição/genética , Proteínas Wnt/genética , Ductos Mesonéfricos/anormalidades
8.
Fertil Steril ; 115(2): 525-527, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33069370

RESUMO

OBJECTIVE: To describe the treatments of a patient using the laparoscopic Davydov's method for Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and ureteral reimplantation for hydronephrosis and hydroureter. DESIGN: Surgical video article. A consent form from the patient was obtained as appropriate; the nature of the study did not necessitate ethics committee approval. There were no conflicts of interest. SETTING: University hospital. PATIENT(S): A 28-year-old woman who presented at our gynecology department with the symptoms of primary amenorrhea and difficult intercourse. She had repaired congenital rectovestibular fistula and imperforate anus at the age of 8. At physical examination, she had a phenotypically normal vulva with a vaginal small pouch (0.5 cm). Magnetic resonance imaging of the pelvis revealed normal ovaries, a primordial uterus, absence of vaginal canal, and a 4.0 × 4.2 × 4.0 cm cystic structure posterior to the bladder. Magnetic resonance urography showed right to left renal crossed-ectopia with inferior fusion, and hydronephrosis and hydroureter from the superior kidney with Grade Ⅳ vesicoureteral reflux. Karyotype was 46, XX. INTERVENTION(S): Saline solution 300 mL was injected into the rectovesical space with an infusion of diluted adrenaline (1:200,000). The goal of this injection was to aid in the identification of tissue planes and reduce blood loss. The space between urethra/bladder and rectum progressively was dissected. Blunt dissection was performed initially with digital separation of tissues. Then, an 8-cm-long neovaginal vault of about 3 cm in diameter was created. The mobilized peritoneum was pulled downward with eight Vicryl sutures and connected to the vaginal epithelium. By cystoscope, we found the left orifice but could not find the right orifice of the hydroureter. Then we ligated the hydroureter by 2-0 absorbable suture near the cyst and cut off the hydroureter, and then incised of all the layers at the top of the bladder to make a bladder flap. We placed the 5 Fr double J stent in the hydroureter and the bladder and anastomozed with the ureteral stump (3-0 Vicryl). Then we removed the cyst laparoscopically. We performed a purse-string stitch to create the apex of the neovagina by taking posterior serosa of the bladder, the pelvic peritoneum between the ovary and rectum, primordial uterus, and anterior rectal serosa. MAIN OUTCOME MEASURE(S): Measurement of the final canal length, sexual function (Female Sexual Function Index), and degree of hydronephrosis. RESULT(S): Three days later, we started to change the vaginal mold and the patient was advised to wear it day and night for the first postoperative month. The vaginal mold had to be worn each night until normal sexual intercourse was possible. Findings confirmed the cyst was Gartner's duct cyst. One year after the surgery, the final canal length was 9 cm and Female Sexual Function Index score was 28. The ultrasound showed that the degree of hydronephrosis of upper moiety was mild. CONCLUSION(S): The distal Wolffian ducts in the female are absorbed but may persist as vestigial remnants (Gartner's duct cysts). A few cases of the combined urogenital-Wolffian anomalies are reported; most of them are associated with the anomalies of müllerian duct fusion, such as Herlyn-Werner-Wunderlich syndrome (uterus didelphys, obstructed hemivagina, and mesonephric duct anomalies). The embryogenesis of the combined anomalies is not completely understood. With comprehensive preoperative assessments, laparoscopic surgery could be a safe and effective treatment to these cases.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Coristoma/cirurgia , Anormalidades Congênitas/cirurgia , Cistos/cirurgia , Rim , Laparoscopia/métodos , Ductos Paramesonéfricos/anormalidades , Ductos Mesonéfricos/cirurgia , Transtornos 46, XX do Desenvolvimento Sexual/complicações , Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico por imagem , Adulto , Coristoma/complicações , Coristoma/diagnóstico por imagem , Anormalidades Congênitas/diagnóstico por imagem , Cistos/complicações , Cistos/diagnóstico por imagem , Feminino , Humanos , Ductos Paramesonéfricos/diagnóstico por imagem , Ductos Paramesonéfricos/cirurgia , Cirurgia Vídeoassistida/métodos , Ductos Mesonéfricos/diagnóstico por imagem
9.
Am J Surg Pathol ; 45(4): 543-549, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33284194

RESUMO

The current World Health Organization (WHO) classification of adenocarcinoma of the urinary tract including the urethra includes uncommon Müllerian-derived carcinomas such as clear cell and endometrioid adenocarcinomas. The concept of primary mesonephric (Wolffian-derived) adenocarcinoma (MA) in the urethra (and urinary tract in general) is currently regarded as controversial as the term "mesonephric" had been also inaccurately applied in the past to label Müllerian-derived carcinomas, particularly clear cell adenocarcinoma. Further, pathologically well-documented or bona fide urethral MAs have not yet to be reported. Herein, we describe 2 examples of MA in elderly females that primarily presented in the urethra and manifested clinically with obstructive lower urinary tract symptoms. Both tumors exhibited histology similar to those in MAs of the female genital tract including the distinctive tubular proliferations with luminal eosinophilic materials. The first case, in addition, showed a variety of patterns including ductal (glandular), solid, fused/sieve-like tubules, dilated tubules, and spindled cells. The second case also showed a transition to the more irregular and poorly formed tubular proliferation of cells with greater nuclear atypia and with a desmoplastic response. Both tumors showed positivity for PAX8, GATA3, and luminal CD10, and 1 tumor analyzed harbored KRAS and ARID1A mutations. One patient received neoadjuvant chemotherapy and underwent resection but had local tumor recurrence and metastasis to the lungs and lumbar spine 12 months after presentation. In conclusion, MA, similar to those occurring in the female genital tract and distinct from the recognized Müllerian-derived carcinomas, may present primarily as urethral tumors. MA in the urethra probably shares a common pathogenesis with vaginal MA as both may originate from the same caudal loci of mesonephric remnants along the closely apposed anterior vaginal and posterior urethral walls. MA should be considered in future classifications for urethral tumors and we recommend that the confusing term "mesonephroid adenocarcinoma" should no longer be used.


Assuntos
Adenocarcinoma/patologia , Neoplasias Uretrais/patologia , Ductos Mesonéfricos/patologia , Adenocarcinoma/química , Adenocarcinoma/genética , Adenocarcinoma/terapia , Idoso , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Quimioterapia Adjuvante , Feminino , Humanos , Terapia Neoadjuvante , Resultado do Tratamento , Neoplasias Uretrais/química , Neoplasias Uretrais/genética , Neoplasias Uretrais/terapia , Procedimentos Cirúrgicos Urológicos , Ductos Mesonéfricos/química
10.
Am J Surg Pathol ; 45(4): 498-506, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33165093

RESUMO

Mesonephric adenocarcinoma (MA) and mesonephric-like adenocarcinoma (MLA) are uncommon neoplasms of the gynecologic tract that have until recently been poorly understood. Although their morphologic, immunohistochemical, and molecular profiles have been recently defined, little is known about their clinical behavior. Small studies have demonstrated inconsistent findings and no large studies have examined the clinical behavior of these adenocarcinomas. In this multi-institutional study, representing the largest and most stringently defined cohort of cases to date, we examined the clinicopathologic features of 99 MAs and MLAs (30 MAs of the uterine cervix, 44 MLAs of the endometrium, and 25 MLAs of the ovary). Only tumors with characteristic mesonephric morphology and either immunohistochemical or molecular support were included. Our results demonstrate that the majority of mesonephric neoplasms presented at an advanced stage (II to IV) (15/25 [60%] MA of the cervix, 25/43 [58%] MLA of the endometrium, and 7/18 [39%] MLA of the ovary). The majority (46/89 [52%] overall, 12/24 [50%] MA of the cervix, 24/41 [59%] MLA of the endometrium, and 10/24 [42%] MLA of the ovary) developed recurrences, most commonly distant (9/12 [75%] MA of the cervix, 22/24 [92%] MLA of the endometrium, and 5/9 [56%] MLA of the ovary). The 5-year disease-specific survival was 74% (n=26) for MA of cervix, 72% (n=43) for MLA of endometrium, and 71% (n=23) for MLA of ovary. Our results confirm that mesonephric neoplasms are a clinically aggressive group of gynecologic carcinomas that typically present at an advanced stage, with a predilection for pulmonary recurrence.


Assuntos
Adenocarcinoma/secundário , Neoplasias do Endométrio/patologia , Neoplasias Ovarianas/patologia , Neoplasias do Colo do Útero/patologia , Ductos Mesonéfricos/patologia , Adenocarcinoma/química , Adenocarcinoma/genética , Adenocarcinoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Bases de Dados Factuais , Neoplasias do Endométrio/química , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/terapia , Feminino , Humanos , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , América do Norte , Irlanda do Norte , Neoplasias Ovarianas/química , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/terapia , Intervalo Livre de Progressão , Sistema de Registros , Fatores de Tempo , Neoplasias do Colo do Útero/química , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/terapia , Ductos Mesonéfricos/química
11.
Anat Rec (Hoboken) ; 304(5): 1119-1135, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33022119

RESUMO

We studied the male reproductive tract of individuals of different body sizes of Caecilia thompsoni to describe morphological characteristics in comparison to other Gymnophiona. The reproductive tract consists of paired testes segmented into chains of primary and secondary lobes, sperm ducts that empty to Wolffian ducts, the cloaca that receives the Wolffian ducts and possesses a phallodeum. Müllerian ducts are present and develop into paired glands that empty into the cloacal urodeum. Testicular secondary lobes contain lobules with cysts of the entire germinal cell line, whereas primary lobes, in the terminal ends of the chains, only have spermagonia, Sertoli cells, and connective tissue. The smallest individual examined (21 cm body length) was immature and only possessed a few testicular primary lobes. Once the individuals reach sexual maturity, the morphological characteristics are quite consistent at macroscopic and histological level among males of very different body sizes. The histological features of the Wolffian and Müllerian glands suggest a complementary secretory role between the two ducts. In the cloaca we found the propulsor muscle, venous sinuses, and blind sacs in the phallodeum, which differentiate C. thompsoni from other species of the genus. Despite these slight differences, the general morphological characteristics, both macroscopic and microscopic, of the reproductive tracts of adult males of C. thompsoni follow the pattern known for the reproductively active males of Gymnophiona.


Assuntos
Anfíbios/anatomia & histologia , Ductos Paramesonéfricos/anatomia & histologia , Células de Sertoli/citologia , Espermatogônias/citologia , Testículo/anatomia & histologia , Ductos Mesonéfricos/anatomia & histologia , Animais , Masculino
12.
Medicine (Baltimore) ; 99(48): e23450, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235131

RESUMO

RATIONALE: Mesonephric-like adenocarcinoma (MLA) from ovary is a very rare tumor which derives from mesonephric duct remnant of the female genital tract. Only six cases have been reported so far in the English literature. PATIENT CONCERNS: A 29-year-old female patient was referred to the local hospital with a 20-day history of abdominal discomfort. DIAGNOSES: Pelvic ultrasound examination revealed a solid and cystic mass measuring 10 cm in diameter in the right adnexal area and a cystic mass measuring 5 cm in the left adnexal area. Postoperative pathology in the local hospital revealed suspected malignancy of the right ovary, and she was then transferred to our institution for definite diagnosis. The tumor mass was finally diagnosed as a primary MLA arising from the right ovary by histological and immunohistochemical examination in our institution. INTERVENTIONS: The patient underwent laparoscopic right adnexectomy and removal of left ovarian cyst in the local institution. Then, she underwent a complete staging surgery including a total hysterectomy, left adnexectomy, pelvic plus para-aortic lymphadenectomy, and omentectomy in our hospital. In addition, she received four cycles of combination chemotherapy with carboplatin plus paclitaxel. OUTCOMES: There is no evidence of recurrence with 13 months of follow-up till now, and we are still following-up this patient. LESSONS: MLA is an extremely uncommon malignancy with difficult diagnosis, unclear treatment and poor prognosis. Familiarizing with the clinical features and optimal management of this rare tumor may increase awareness of the disease among clinicians and pathologists, thus avoiding the misdiagnosis and mistreatment.


Assuntos
Adenocarcinoma/patologia , Neoplasias Ovarianas/patologia , Adenocarcinoma/terapia , Adulto , Quimioterapia Adjuvante , Feminino , Humanos , Neoplasias Ovarianas/terapia , Doenças Raras/patologia , Ductos Mesonéfricos/patologia
13.
Rev. medica electron ; 42(5): 2388-2397, sept.-oct. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144742

RESUMO

RESUMEN Los quistes de los conductos de Gartner, generalmente pequeños, benignos y asintomáticos, son vestigios del canal mesonéfrico de Wolff. Representan el 11 % de los quistes vaginales, esta es su localización más frecuente según la literatura consultada. Se presentó un caso operado en el Hospital Militar de Matanzas "Dr. Mario Muñoz Monroy", de localización en la cara posterior del istmo uterino (AU).


ABSTRAC Gartner's duct cyst, mostly little, benign and asymptomatic, are vestiges of the Wolffian mesonephric duct representing 11 % of the vaginal cysts; this location is the most frequently reported and published one up to date. The authors presented the case of a patient who underwent a surgery in the Military Hospital "Dr. Mario Muñoz Monroy¨ with a cyst in the posterior side of the uterine isthmus (AU).


Assuntos
Humanos , Feminino , Adulto , Ductos Mesonéfricos/anormalidades , Cistos/epidemiologia , Útero/anormalidades , Ductos Mesonéfricos/cirurgia , Ultrassonografia/métodos , Cistos/cirurgia , Cistos/diagnóstico
14.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(4): 570-572, 2020 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895114

RESUMO

This article reports a patient who suffered from Wolffian adnexal tumor.We also briefly elucidate the pathogenesis,clinicopathological features,diagnosis,differentiation,and treatment of Wolffian adnexal tumor,with an attempt to increase the awareness of the disease and reduce misdiagnosis.


Assuntos
Adenoma , Doenças dos Anexos , Feminino , Humanos , Imuno-Histoquímica , Ductos Mesonéfricos
15.
JNMA J Nepal Med Assoc ; 58(227): 505-507, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32827015

RESUMO

Paramesonephric duct or Mullerian ducts forms female genital organs whereas mesonephric duct forms male genital organs. The remnant of the mesonephric duct or Wolffian duct in females sometimes forms a mesonephric cyst or Gartner's duct cyst. They are usually asymptomatic and <2 cm but sometimes can be bigger. It is diagnosed with pelvic examination. It is treated with surgical excision of the cyst. This is a unique case in urogynecology as it confuses with pelvic organ prolapse and the mode of treatment is completely different. We report a case of 32-years old lady who presented in urogynecology outpatient department with complain of pelvic organ prolapse. After examination she was diagnosed as vaginal cyst and excision was done and confirmed as Gartners cyst in histopathological examination.


Assuntos
Cistos , Doenças Vaginais , Ductos Mesonéfricos , Adulto , Cistos/diagnóstico , Cistos/cirurgia , Feminino , Humanos , Ultrassonografia , Vagina/cirurgia , Doenças Vaginais/diagnóstico por imagem , Doenças Vaginais/cirurgia , Ductos Mesonéfricos/diagnóstico por imagem , Ductos Mesonéfricos/cirurgia
16.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(2): 75-77, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193715

RESUMO

El síndrome de Herlyn-Werner-Wünderlich es una anomalía congénita rara del tracto urogenital que afecta a los conductos de Müller y de Wolff con la tríada útero didelfo, obstrucción de hemivagina y agenesia renal ipsilateral. Las pacientes suelen estar asintomáticas hasta la menarquía, y a partir de entonces la clínica dependerá del grado de obstrucción vaginal, apareciendo frecuentemente masa y dolor pélvico. El diagnóstico suele ser radiológico, siendo de elección la resonancia de abdomen y pelvis que nos confirmará las alteraciones genitourinarias en su totalidad, y el tratamiento es quirúrgico con resección del tabique y drenaje de la vagina obstruida


Herlyn-Werner-Wünderlich syndrome is a rare congenital anomaly of the urogenital tract affecting the Müller and Wolff ducts with the uterus didelphys triad, hemivagina obstruction and ipsilateral renal agenesis. Patients are usually asymptomatic until menarche and thereafter the clinical practice will depend on the degree of vaginal obstruction, with frequently appearing mass and pelvic pain. The diagnosis is usually radiological, with the resonance of abdomen and pelvis chosen that will confirm us the genitourinary alterations in its totality and the treatment is surgical with resection of the septum and drainage of the obstructed vagina


Assuntos
Humanos , Feminino , Adolescente , Anormalidades Urogenitais/diagnóstico por imagem , Anormalidades Urogenitais/cirurgia , Dismenorreia/etiologia , Anormalidades Congênitas/diagnóstico , Ductos Paramesonéfricos/patologia , Ductos Mesonéfricos/anormalidades , Ductos Mesonéfricos/patologia , Hematocolpia/diagnóstico por imagem , Dor Abdominal/etiologia , Síndrome
17.
Pediatr Res ; 88(3): 382-390, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32015493

RESUMO

BACKGROUND: Vesicoureteral reflux (VUR), backflow of urine into the kidney, is associated with urinary tract infections and chronic kidney disease. Integrity of the vesicoureteral junction (VUJ), where reflux occurs, is determined largely by proper induction of the ureteric bud from the Wolffian duct. Induction is modulated by signals from the surrounding peri-Wolffian duct stroma. We evaluated whether miRNAs in the peri-Wolffian duct stroma are necessary for proper ureteric induction, VUJ formation, and suppression of VUR. METHODS: We generated a mouse with loss of miRNAs in the peri-Wolffian duct stroma. We evaluated embryos for ureteric bud induction defects and expression of genes that regulate induction. We performed cystograms to assess for reflux and assessed VUJs in postnatal mice. RESULTS: Mutant embryos had cranially displaced ureteric bud induction sites vs. controls. We observed no changes in expression of genes known to regulate induction. While mutants were early postnatal lethal, they had high rates of VUR vs. controls. Mutant VUJs that refluxed had low inserting ureters and shortened intravesicular tunnels vs. non-refluxing mice. CONCLUSIONS: We found that miRNAs in the peri-Wolffian duct stroma are required for normal ureteric bud induction, VUJ formation, and prevention of VUR.


Assuntos
RNA Helicases DEAD-box/genética , Deleção de Genes , Regulação da Expressão Gênica no Desenvolvimento , Rim/metabolismo , Ribonuclease III/genética , Ureter/metabolismo , Bexiga Urinária/metabolismo , Refluxo Vesicoureteral/genética , Ductos Mesonéfricos/metabolismo , Animais , Apoptose , Cruzamentos Genéticos , Feminino , Fluorescência , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Mesoderma/patologia , Camundongos , Camundongos Knockout , Camundongos Transgênicos , MicroRNAs/metabolismo , Microscopia de Fluorescência , Mutação
18.
Int J Gynecol Pathol ; 39(6): 546-551, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31985582

RESUMO

Mesonephric adenocarcinoma (MA) is a rare tumor of the female genital tract that develops in the uterine cervix. Recently, a few cases of MA arising from the uterine body have been reported, whereas the differences between these 2 entities remain unknown. Two uterine MAs and 1 cervical MA were included in this study. In uterine MA, there was an admixture of various growth patterns with tubular, glandular, slit-like, papillary, and solid architectures. Both tumors extensively involved the endometrium, while no mesonephric remnants were noted. Immunostaining was diffusely positive for TTF-1, while there was only focal staining for GATA3. KRAS somatic mutation was present in both uterine cases. In cervical MA, the tumor also had different growth patterns but no endocervical mucosa involvement. A residual mesonephric duct was present. GATA3 showed diffuse staining, but TTF-1 was totally negative. Therefore, uterine MA was not entirely consistent with its cervical counterpart in both morphologic characteristics and immunostaining.


Assuntos
Adenocarcinoma/patologia , Neoplasias do Colo do Útero/patologia , Neoplasias Uterinas/patologia , Ductos Mesonéfricos/patologia , Adenocarcinoma/cirurgia , Colo do Útero/patologia , Feminino , Fator de Transcrição GATA3/análise , Humanos , Histerectomia , Imuno-Histoquímica , Excisão de Linfonodo , Pessoa de Meia-Idade , Mutação , Miométrio/patologia , Proteínas Proto-Oncogênicas p21(ras)/genética , Salpingo-Ooforectomia , Neoplasias Uterinas/cirurgia
19.
Int Urogynecol J ; 31(1): 55-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31471622

RESUMO

INTRODUCTION AND HYPOTHESIS: Gartner's duct cysts (GDC) are benign lesions that may become symptomatic, leading to surgical intervention. There is no standard surgical technique for management of GDC. This article provides a comprehensive review of surgical the management of GDC. We also present a new technique using fluorescein dye to help delineate GDC walls and facilitate complete cyst excision. METHODS: We conducted a PubMed search for English-language articles without a defined time range. The search combined subject headings, title, abstract, and text words relating to Gartner duct cysts. Articles describing surgical management of GDC were included. Exclusion criteria included inadequate diagnosis of GDC, infected cysts, nonsurgical management, or article unavailable for interlibrary loan. A novel approach using intra-cyst fluorescein dye injection is described. RESULTS: Two hundred sixty-seven articles were identified via PubMed, and 34 articles were included in the review based on eligibility criteria. Concomitant genitourinary malformations occurred in 19 of the 92 surgically managed patients. Surgical techniques included cyst excision (50 patients), tetracycline injection following aspiration (15), marsupialization (14), unroofing/partial excision (9), and puncture/evacuation (4). Recurrences occurred in 4, 1, 0, 0, and 1 patient, respectively. One patient underwent uncomplicated fluorescein dye-assisted cyst excision with no recurrence 30 months post-procedure. CONCLUSIONS: The low incidence of GDCs necessitating surgical intervention has resulted in a lack of standard surgical technique, especially in patients with concurrent genitourinary malformations. Utilizing fluorescein dye provides a surgical method that can help confirm the absence of urologic involvement as well as facilitate precise excision of GDC.


Assuntos
Cistos/cirurgia , Fluoresceína , Procedimentos Cirúrgicos em Ginecologia , Ductos Mesonéfricos/cirurgia , Feminino , Humanos
20.
J Dev Orig Health Dis ; 11(1): 78-85, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31412963

RESUMO

Several life-threatening diseases of the kidney have their origins in mutational events that occur during embryonic development. In this study, we investigate the role of the Wolffian duct (WD), the earliest embryonic epithelial progenitor of renal tubules, in the etiology of autosomal dominant polycystic kidney disease (ADPKD). ADPKD is associated with a germline mutation of one of the two Pkd1 alleles. For the disease to occur, a second event that disrupts the expression of the other inherited Pkd1 allele must occur. We postulated that this secondary event can occur in the pronephric WD. Using Cre-Lox recombination, mice with WD-specific deletion of one or both Pkd1 alleles were generated. Homozygous Pkd1-targeted deletion in WD-derived tissues resulted in mice with large cystic kidneys and serologic evidence of renal failure. In contrast, heterozygous deletion of Pkd1 in the WD led to kidneys that were phenotypically indistinguishable from control in the early postnatal period. High-throughput sequencing, however, revealed underlying gene and microRNA (miRNA) changes in these heterozygous mutant kidneys that suggest a strong predisposition toward developing ADPKD. Bioinformatic analysis of this data demonstrated an upregulation of several miRNAs that have been previously associated with PKD; pathway analysis further demonstrated that the differentially expressed genes in the heterozygous mutant kidneys were overrepresented in signaling pathways associated with maintenance and function of the renal tubular epithelium. These results suggest that the WD may be an early epithelial target for the genetic or molecular signals that can lead to cyst formation in ADPKD.


Assuntos
Túbulos Renais/embriologia , Rim Policístico Autossômico Dominante/genética , Insuficiência Renal/genética , Canais de Cátion TRPP/genética , Ductos Mesonéfricos/patologia , Alelos , Animais , Modelos Animais de Doenças , Epitélio/embriologia , Epitélio/patologia , Feminino , Mutação em Linhagem Germinativa , Humanos , Túbulos Renais/patologia , Camundongos , Camundongos Knockout , Rim Policístico Autossômico Dominante/sangue , Rim Policístico Autossômico Dominante/complicações , Rim Policístico Autossômico Dominante/patologia , Insuficiência Renal/sangue , Insuficiência Renal/diagnóstico , Insuficiência Renal/patologia , Transdução de Sinais/genética , Ductos Mesonéfricos/embriologia
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