Mesonephric-like adenocarcinoma as an unexpected histological result after fertility saving procedure for presumed adenomyosis: a case report

Vojtěch Lukavec, Filip Frühauf, Zdeňka Lisá, Jan Galko, Pavel Dundr, Michal Mára
In: Frontiers in Oncology · 2026 · vol. 16 · doi:10.3389/fonc.2026.1828586 · W7163636181
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

A 41-year-old patient initially treated for presumed adenomyosis was unexpectedly diagnosed with mesonephric-like adenocarcinoma following fertility-sparing surgery, requiring further treatment.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a 41-year-old woman with primary infertility and heavy menstrual bleeding whose 5–6 cm diffusely abnormal myometrial lesion was diagnosed as diffuse adenomyosis on ultrasound; an open cytoreductive resection with uterine cavity reconstruction was planned to support fertility treatment. Histopathology and immunohistochemistry of the resected tissue unexpectedly showed extensive mesonephric-like adenocarcinoma, with minimal benign endometrial tissue, leading to staging work-up and definitive surgery (total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy), which revealed deep myometrial invasion, ovarian metastasis, and lymph node involvement, later confirmed by CT as diffuse carcinomatosis. The patient then received six cycles of carboplatin/paclitaxel with concurrent pembrolizumab followed by maintenance pembrolizumab, achieving partial response with later progression limited to paraaortic lymph nodes, which were surgically debulked with no residual disease. This paper is centrally about endometriosis/adenomyosis differential diagnosis — it reports a mesonephric-like adenocarcinoma that mimicked presumed diffuse adenomyosis and was discovered after a fertility-sparing procedure, directly relating to adenomyosis.

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Abstract

Introduction We report an unexpected case of mesonephric-like adenocarcinoma initially treated as a diffuse adenomyosis in a patient presenting with primary infertility. The aim of this report is to raise clinical awareness about the risk of a diagnostic pitfall where an unexpected malignancy can mimic diffuse adenomyosis. The patient’s main concerns and important clinical findings: A 41-year-old patient referred to a tertiary minimally invasive gynecological center in June 2023 for primary infertility, heavy menstrual bleeding, and a 5 x 6 cm myometrial mass diagnosed as diffuse adenomyosis on ultrasound scan. The primary diagnoses, interventions, and outcomes An open cytoreductive resection of adenomyosis with uterine cavity reconstruction was planned due to worsening abnormal uterine bleeding and two failed in vitro fertilization attempts. An unexpected Mesonephric-like adenocarcinoma with only small foci of healthy tissue was identified on histopathological examination, and immunohistochemical staining. Consequently, the patient had a total abdominal hysterectomy with bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy. This was followed by six cycles of paclitaxel and carboplatin plus pembrolizumab-based immunotherapy. Conclusions This case highlights the importance of thorough evaluation of all atypical myometrial lesions, including adenomyosis, where pre-conception surgical excision and histopathological evaluation are often deferred in most patients.

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