# Two Cases of Mesonephric-Like Adenocarcinoma Arising From Ovary and Peritoneal and Literature Review

## TL;DR

This paper reports two rare cases of mesonephric-like adenocarcinoma in patients with endometriosis history and reviews 66 cases to understand clinical features and outcomes.

## Contribution

The first documented case of primary peritoneal mesonephric-like adenocarcinoma and insights into its association with endometriosis and surgical intervention.

## Key findings

- Primary peritoneal MLA is rare and has a poor prognosis similar to serous carcinoma.
- Complete surgical resection improves outcomes for ovarian MLA.
- Endometriosis history may be linked to MLA development, especially after surgery.

## Abstract

Reports of Mesonephric-like adenocarcinoma (MLA) arising from other than the ovary and uterus are exceedingly rare. This report details two cases of MLA in patients with a history of endometriosis. One of these two cases is believed to be the first documented case of primary peritoneal MLA.

The first case was a 64-year-old woman with a history of hysterectomy and oophorectomy for endometriosis. She presented with International Federation of Gynecology and Obstetrics (FIGO) stage IVB primary peritoneal MLA, diagnosed eight years later via CT-guided biopsy and immunohistochemistry. Despite multiple chemotherapy regimens, she died 13 months after initiation of treatment. The second case was a 72-year-old woman with a history of endometriosis, and she was diagnosed with FIGO stage IIIA1(i) ovarian MLA. She underwent complete cytoreductive surgery followed by adjuvant paclitaxel and carboplatin chemotherapy and remained recurrence-free for three years. A literature review of 66 reported cases of ovarian MLA was conducted to compare clinical characteristics, treatment, and prognosis. According to these findings, 55% were diagnosed at an early stage (FIGO I-II), and prognosis was generally favorable after complete surgical resection, but outcomes were poor for sub-optimally resected cases.

These cases suggest a potential link between MLA development and a history of endometriosis, particularly after surgical intervention. The prognosis for MLA is highly dependent on achieving complete surgical resection. Advanced-stage primary peritoneal MLA has a poor prognosis, comparable to conventional primary peritoneal serous carcinoma. Given the difficulty of preoperative diagnosis, diligent follow-up is recommended for high-risk patients with a history of endometriosis. Future research is needed to establish effective treatments for advanced or recurrent disease.