Wolffian Tumors of the Female Genital Tract: A Study of 32 Cases
Deborah DeLair, Koen Van de Vijver, Kay J Park, Esther Oliva. Memorial Sloan-Kettering Cancer Center, New York, NY; Massachusetts General Hospital, Boston, MA
Background: Wolffian tumors of the female genital tract (FGT), including mesonephric adenocarcinoma (MA) and female adnexal tumor of probable Wolffian origin (FATWO), arise from remnants of the mesonephric (Wolffian) system. Their diagnosis is often problematic due to their low frequency as well as overlapping histologic features with other FGT tumors. Behavior is also not well known as only small series have been reported.
Design: Files of 2 institutions were searched, including Dr. R. Scully's consultation files. Glass slides and medical records were reviewed and relevant clinicopathologic features were recorded.
Results: A total of 32 tumors were identified, including 26 FATWOs and 6 MAs. Average patient age was 45 years. FATWOs originated from ovary (n=16), fallopian tube (n=9), and pelvis/retroperitoneum (n=1). All MAs arose in the cervix (n=6). FIGO stage at presentation was as follows: I:23, II:4, III:2, and IV:3. Average tumor diameter was 7.6 cm and average mitotic index (MI) was 4.65 /10 high power fields (HPF). Mesonephric rests were identified in all 6 MAs and 6 FATWOs. Eosinophilic secretions and necrosis were present in 20 and 12 tumors respectively. One FATWO had focal sarcomatous transformation. Almost all of both FATWOs and MAs (29/32) had more than one growth pattern, the most common being tubular, cystic, or sieve-like. Other growth patterns included solid, spindled, sertoliform, retiform, and pseudoendometrioid. Two MA and one FATWO had only tubular growth. The stroma was frequently hyalinized. FATWOs in the ovary usually had a multinodular growth pattern compared to other locations. Immunohistochemical studies were available in selected cases with the following positive results: inhibin 4/6, calretinin 8/11, (both usually focal) ER 1/11 (focally), PR 0/11, CD10 10/10, CK7 5/5, PAX8 5/5, EMA 3/4, p16 0/7, CEA 0/3, p53 0/5, HNF1-β 2/6, FOXL2 1/1. Follow-up was available for 23/32 patients (average 73 months); 16 had no evidence of disease, 5 are alive with disease (AWD), 1 died of disease (DOD), and 1 died of another cause. Patients DOD or AWD presented at advanced stage and had an average MI of 14/10 HPF, these included 4 FATWOs from the ovary (including the tumor with sarcomatous transformation) and 2 MAs.
Conclusions: FATWOs and MAs usually present at low stage and have a favorable clinical outcome. They often show a background of mesonephric rests, heterogeneous growth pattern, eosinophilic secretions, and a low MI. Factors associated with malignant behavior included high stage at presentation and high MI.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 9:00 AM
Platform Session: Section E, Tuesday Morning