Definition/General
Introduction:
Cervical mesonephric remnants are benign developmental structures representing persistent remnants of the embryonic mesonephric (Wolffian) duct system
These structures normally regress in females during embryonic development.
Origin:
Derived from embryonic mesonephric (Wolffian) ducts that normally regress in female embryos
Persistence of these structures results in small tubular remnants within cervical stroma.
Classification:
WHO Classification categorizes as benign developmental remnant
Part of mesonephric duct derivatives
May be tubular, cystic, or solid depending on degree of involution.
Epidemiology:
Present in most women as microscopic remnants
Clinically apparent lesions rare
No age predilection
Incidental finding in majority of cases.
Clinical Features
Presentation:
Usually asymptomatic and incidental microscopic finding
Rarely may present as palpable cervical mass or cyst
Often discovered during routine histological examination.
Symptoms:
Typically asymptomatic
Large cysts may cause cervical enlargement
Rarely associated with dyspareunia
May cause cervical irregularity on examination.
Risk Factors:
No specific risk factors
Represents normal developmental variation
Not associated with hormonal factors or environmental influences.
Screening:
Incidental finding on routine examination
Not detected by routine screening methods
May be identified on ultrasound as small cervical cysts.
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Gross Description
Appearance:
Small, tubular or cystic structures within cervical stroma
Usually microscopic
When visible, appear as small white or translucent nodules.
Characteristics:
Size typically microscopic (<1 mm)
White to translucent appearance
Firm consistency
May contain clear fluid if cystic.
Size Location:
Located deep within cervical stroma, usually lateral aspects
Size ranges from microscopic to few millimeters
Multiple small structures common.
Multifocality:
Often multiple small remnants
Bilateral distribution common
May be scattered throughout cervical stroma.
Microscopic Description
Histological Features:
Small tubular structures lined by single layer of cuboidal to low columnar epithelium
No surrounding specialized stroma
Clear to eosinophilic luminal contents.
Cellular Characteristics:
Epithelial lining: cuboidal to low columnar cells
Uniform nuclei without atypia
Scant cytoplasm
No mitotic activity
Basement membrane intact.
Architectural Patterns:
Small, round to oval tubular structures
May be solid, tubular, or cystic
No complex branching patterns
Surrounded by normal cervical stroma.
Grading Criteria:
Benign developmental structure (no grading applicable)
Distinguished by bland morphology and characteristic location.
Immunohistochemistry
Positive Markers:
PAX8 positive (characteristic marker)
CK7 positive
Calretinin positive
CD10 negative (unlike endometrial stroma).
Negative Markers:
Estrogen receptor (ER) negative
Progesterone receptor (PR) negative
CEA negative
TTF-1 negative.
Diagnostic Utility:
PAX8 is most useful diagnostic marker for mesonephric remnants
Negative hormone receptors distinguish from endocervical glands.
Molecular Subtypes:
No molecular subtypes
Represent embryological developmental remnants without neoplastic potential.
Molecular/Genetic
Genetic Mutations:
No genetic mutations associated
Represent normal embryological structures with arrested development rather than neoplastic process.
Molecular Markers:
PAX8 expression characteristic
No hormonal responsiveness
Normal cellular genetics
No proliferative activity.
Prognostic Significance:
Completely benign with no clinical significance
No malignant potential
No association with increased cancer risk.
Therapeutic Targets:
No treatment required
Observation only
Surgical intervention not indicated unless large and symptomatic.
Differential Diagnosis
Similar Entities:
Endocervical glands
Endometriosis
Adenomyosis
Mesonephric adenocarcinoma
Tunnel clusters
Nabothian cysts.
Distinguishing Features:
Mesonephric remnants: PAX8+, hormone receptors-
Endocervical: CEA+, hormone receptors+
Endometriosis: CD10+ stroma.
Diagnostic Challenges:
Small size makes identification difficult
Distinction from other glandular structures
Recognition of characteristic immunoprofile.
Rare Variants:
Mesonephric hyperplasia
Florid mesonephric remnants
Cystic mesonephric remnants.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Prognostic Factors
Prognostic factors: [list factors]
Final Diagnosis
Final diagnosis: [complete diagnosis]