A CASE OF MESONEPHRIC ADENOCARCINOMA ARISING FROM THE GARTNER'S DUCT CYST

Abstract

A 61-year-old female was admitted because of urinary retention. A soft, fluctuated mass was palpated on the anterior wall of the vagina by pelvic examination. IVP revealed a mass protruding upward toward the bladder neck, which was similar to BPH in male patients. The mucosa of the bladder and urethra was normal cystourethroscopically. Ultrasonography by the transrectal radial scanning and CT revealed a mass consisting of fluid and solid components around the urethra. Bloody fluid obtained through the transvaginal puncture from the paraurethral mass was malignant cytologically.
The anterior pelvic exenteration and urinary diversion were carried out subsequently. The cystic tumor was located between the urethra and the vagina, and the urethra was surrounded by the tumor circumferentially. With careful inspection of the resected specimen, the papillary component was seen arising from the cystic wall. Histologically the epithelium of the cystic wall had one layer of cuboidal cells and the papillary tumor had tubular structures consisting of cancer cells with large nucleoli and clear cytoplasm. The mucosa of the urethra and the vagina was intact. The histological diagnosis was mesonephric adenocarcinoma arising from the Gartner's duct cyst. She had unevenful postoperative course and was discharged after irradiation of 4400 rad to the pelvic cavity.
The mesonephric adenocarcinoma was reported first by Schiller as “mesonephroma ovarii” in 1939. Although the origin of the mesonephroma was thought to be mesonephric remnants at that time, the persuasive theory on the histogenesis is not yet concluded so far. Herein we reviewed the reported theories regarding the origin of the mesonephric adenocarcinoma through the perusal of Japanese and English literature. Our case was the 11th reported in the urological field.