ReviewMechanismInconclusiveLimited evidenceTier 3 · early human
International journal of surgical pathology · Jun 2026 · comprehensive review
mesonephric-like adenocarcinoma (MLA)mesonephric adenocarcinoma (MA)female genital tractuterine cervix
This is a comprehensive review summarizing clinicopathologic, immunophenotypic, and molecular features of mesonephric-like adenocarcinoma (MLA) of the female genital tract. The authors report that MLA shows diverse histologic patterns, is typically negative or only focally positive for ER, is positive for TTF-1, CD10, and GATA3 immunostains, and often harbors KRAS mutations. They note that MLA resembles mesonephric adenocarcinoma histologically and molecularly but, unlike MA, is not associated with mesonephric remnants. The review aims to improve clinicians' and pathologists' recognition of this rare tumor type.
Key findings
- MLA is a recently recognized rare malignancy of the female genital tract with histomorphology, immunohistochemistry, and molecular characteristics similar to mesonephric adenocarcinoma but not associated with mesonephric remnants.
- Histologic patterns described for MLA include tubule-like, glandular, papillary, solid, sex cord-like, trabecular, retiform, cribriform, glomeruloid, and spindle cell patterns.
- Immunohistochemically, most MLAs show negative or focal weak expression for ER and are positive for TTF-1, CD10, and GATA3.
- Molecularly, these tumors often harbor KRAS gene mutations.
Limitations: This is a narrative review rather than primary original data.; No systematic review or meta-analytic methods are described in the abstract.; MLA is a rare tumor, so primary evidence summarized may be limited in quantity and quality.; The abstract does not report treatment or clinical outcome data..
Provides a clinicopathologic, immunophenotypic, and molecular summary intended to help pathologists and clinicians recognize and diagnose mesonephric-like adenocarcinoma.
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed
Human · observationalMechanismMixed resultsLimited evidenceTier 3 · early humann = 21
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · May 2026
Trastuzumab-deruxtecan-t-dxdmesonephric adenocarcinoma (cervix)mesonephric-like adenocarcinoma (endometrium)mesonephric-like adenocarcinoma (ovary) The authors measured HER2 and FOLR1 protein expression by immunohistochemistry in 21 mesonephric and mesonephric-like gynecologic adenocarcinomas (13 endometrial, 5 ovarian, 3 cervical). HER2 was detectable in 14 of 21 tumors (two cases scored 2+ and many scored 1+, with no 3+ cases), while FOLR1 met MIRV eligibility in one case and ten additional tumors had 5–70% expression. Most tumors did not meet current thresholds for HER2- or FOLR1-targeted monotherapy, but the authors suggest detectable expression could justify exploring T-Dxd and MIRV combinations in selected cases.
Reported effects: Total cases assessed 21 · endometrial cases 13, n=21 · +9 more
Studied with: trastuzumab deruxtecan + mirvetuximab soravtansine.
Key findings
- HER2 expression was present in 14/21 tumors.
- HER2 (2+) was seen in two cases by both EC and GaC criteria; no HER2 (3+) was identified.
- Twelve other cases showed HER2 (1+) by endometrial cancer (EC) criteria; only four met 1+ by GaC criteria.
- FOLR1 met current MIRV treatment criteria in one case; ten other cases showed FOLR1 expression ranging from 5% to 70%.
- Most tumors did not meet current biomarker thresholds for trastuzumab (HER2) or MIRV monotherapy.
Limitations: Small sample size (21 cases).; Observational immunohistochemical study of archival tumors only — no treatment or clinical outcome data provided.; Heterogeneous primary sites (cervix, endometrium, ovary) which may affect biomarker distribution.; Use of different scoring criteria (EC vs GaC) produced discordant HER2 categorization, which may limit generalizability..
AI summary of the abstract, human-reviewed · Jul 2026. Describes what this study reported, not medical advice. View on PubMed
Human · observationalMechanismReported positiveLimited evidenceTier 3 · early humann = 48
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · Nov 2025 · case series
mesonephric adenocarcinomamesonephric-like adenocarcinomaclear cell carcinomamesonephric carcinosarcoma
The authors performed Napsin-A immunohistochemistry on whole-slide sections from 48 mesonephric and mesonephric-like adenocarcinomas and carcinosarcomas. Napsin-A was positive in 17/48 cases (35.4%), with focal granular cytoplasmic staining in 1–40% of cells; positivity occurred in 13/32 MLAs, 2/13 MAs, and 2/3 carcinosarcomas. The study concludes that Napsin-A is expressed in a substantial subset of these tumors and that reliance on a single marker could lead to misclassification as clear cell carcinoma.
Reported effects: Napsin-A positive overall 35.4%, n=48 · Range of focal granular cytoplasmic expression · +3 more
Key findings
- Napsin-A staining was positive in 17 of 48 cases (35.4%), with focal granular cytoplasmic expression ranging from 1% to 40%.
- 13/32 (40.6%) mesonephric-like adenocarcinomas (MLAs) were Napsin-A positive.
- 2/13 (15.4%) mesonephric adenocarcinomas (MAs) were Napsin-A positive.
- 2/3 (66.7%) mesonephric or mesonephric-like carcinosarcomas were Napsin-A positive.
- Because of morphologic and immunohistochemical overlap, Napsin-A expression in MA/MLA may contribute to misclassification as clear cell carcinoma.
Limitations: Observational pathology series without reported clinical outcome correlation; Relatively small overall sample size and very small subgroup sizes (e.g., n=3 carcinosarcomas); Findings are based solely on immunohistochemistry on tissue sections; no clinical or molecular correlation reported in the abstract.
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed
Human · observationalReported negativeLimited evidenceTier 3 · early humann = 91
Journal of clinical medicine · Dec 2024 · systematic review of case reports and case series
mesonephric adenocarcinoma of the uterine cervixcervical mesonephric adenocarcinoma (MNAC)
This systematic review pooled 49 publications describing 91 cases of cervical mesonephric adenocarcinoma. Most reported cases were stage I and hysterectomy was the most common surgical procedure; median follow-up was 29 months. Disease recurrence occurred in about one-third of cases (35.2%) with a median disease-free survival of 24 months; at follow-up 64.8% were in remission and 27.4% died of disease progression. The authors propose an embryologically oriented surgical approach based on their appraisal of existing surgical and adjuvant therapies.
Reported effects: included_publications 49, n=49 · cases_included 91, n=91 · +7 more
Key findings
- 49 publications were included in the analysis, describing 91 MNAC cases.
- Most patients had stage I disease (70.8%) (n = 51).
- Hysterectomy was performed in 77 patients.
- The median follow-up was 29 months (range 1-199 months).
- Disease recurrence was observed in 35.2% (n = 25) of the cases.
- Median disease-free survival (DFS) was 24 months (range 1-199).
- At follow-up, 64.8% (n = 46) of patients remained in remission irrespective of the treatment modality.
- 27.4% (n = 20) died due to disease progression.
Limitations: Evidence derives from case reports and case series rather than controlled trials.; Relatively small total number of cases (91) for pooled inference.; Heterogeneous and retrospectively reported treatments and outcomes across included publications.; Potential publication and selection bias inherent to systematic reviews of case reports/series.; Follow-up duration was variable (range 1–199 months) which may affect comparability of outcomes.; No randomized or controlled data available to support the proposed surgical approach..
Systematic review of clinical characteristics, management, and outcomes of cervical mesonephric neoplasms; proposes an embryology-informed surgical resection strategy.
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed · Full text