Peritoneal Mesonephric-Like Adenocarcinoma Arising in Endometriosis: Case Report and Review of the Literature Expanding the Spectrum of Extrauterine Mesonephric-Like Adenocarcinomas.

BackgroundMesonephric-like adenocarcinoma (MLA) is a rare type of Müllerian carcinoma that poses significant diagnostic challenges, especially at extrauterine sites. Its morphologic and immunophenotypic overlap with other carcinomas can lead to diagnostic confusion or misclassification.Patient PresentationWe describe a 55-year-old woman with a history of endometriosis who developed peritoneal MLA infiltrating the bowel wall, accompanied by nodal and hepatic metastases. The tumor displayed diverse architectural patterns and was composed of cuboidal to columnar cells with moderate cytologic atypia and vesicular chromatin. Immunohistochemistry showed positivity for keratin, PAX8, and TTF-1, with focal positivity for GATA3 and luminal CD10, and focal weak ER staining in <5% of cells; PR was negative. Focal thyroglobulin expression was also present. Molecular testing revealed a KRAS p.G12V activating mutation.DiscussionMLA has a broad differential diagnosis and is often misinterpreted as other neoplasms. Accurate diagnosis requires an integrated assessment of morphology, immunophenotype, and molecular profile. The peritoneal location, particularly in association with endometriosis, raises the possibility of a peritoneal origin.ConclusionPeritoneal MLA is exceptionally rare. Pathologists should consider MLA in the differential diagnosis of peritoneal tumors, particularly those arising in the setting of endometriosis, to ensure accurate classification and appropriate clinical management.