{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T14:23:21Z","timestamp":1780669401104,"version":"3.54.1"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,18]],"date-time":"2021-04-18T00:00:00Z","timestamp":1618704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>We present herein a rare case of uterine serous carcinoma with mesonephric-like differentiation (SC-MLD) initially misdiagnosed as mesonephric-like adenocarcinoma (MLA). A 51-year-old woman underwent total hysterectomy for a uterine tumor. Histologically, the tumor exhibited various architectures, including papillary, glandular, tubular, cribriform, and cystic. On the basis of this architectural diversity accompanied by intraluminal eosinophilic secretions and intermediate-grade nuclear atypia, the initial diagnosis was MLA. However, the tumor was diffusely and strongly positive for the expression of p16 and negative for the expression of GATA-binding protein 3 (GATA3). Furthermore, we identified a pathogenic tumor protein 53 (TP53) mutation affecting an acceptor splice site in intron 9, despite a wild-type p53 immunostaining pattern. The observations of diffuse and strong p16 expression, lack of GATA3 expression, pathogenic TP53 mutation, and wild-type Kirsten rat sarcoma viral oncogene homolog indicate that this tumor was not an MLA but an SC-MLD. Both uterine SC and MLA can exhibit various histological growth patterns. Our comprehensive clinicopathological and molecular analyses can serve to improve the understanding of this rare condition and help pathologists in making an accurate diagnosis.<\/jats:p>","DOI":"10.3390\/diagnostics11040717","type":"journal-article","created":{"date-parts":[[2021,4,18]],"date-time":"2021-04-18T22:15:13Z","timestamp":1618784113000},"page":"717","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Serous Carcinoma of the Endometrium with Mesonephric-Like Differentiation Initially Misdiagnosed as Uterine Mesonephric-Like Adenocarcinoma: A Case Report with Emphasis on the Immunostaining and the Identification of Splice Site TP53 Mutation"],"prefix":"10.3390","volume":"11","author":[{"given":"Sangjoon","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9905-3900","authenticated-orcid":false,"given":"Yoon Yang","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Pathology, Myongji Hospital, Hanyang University College of Medicine, Goyang-si 10475, Gyeonggi-do, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4730-221X","authenticated-orcid":false,"given":"Hyun-Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e043141","DOI":"10.1136\/bmjopen-2020-043141","article-title":"Incidence of omental metastasis in uterine serous carcinoma: Study protocol for a systematic review and meta-analysis","volume":"11","author":"Hu","year":"2021","journal-title":"BMJ Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.3802\/jgo.2020.31.e64","article-title":"Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma","volume":"31","author":"Casarin","year":"2020","journal-title":"J Gynecol. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.3802\/jgo.2020.31.e58","article-title":"Incidence and predictors of peritoneal metastases of gynecological origin: A population-based study in the Netherlands","volume":"31","author":"Burg","year":"2020","journal-title":"J. Gynecol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/jog.13831","article-title":"Guidelines for office gynecology in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2017 edition","volume":"45","author":"Kawaguchi","year":"2019","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.3802\/jgo.2017.28.e12","article-title":"Practice guidelines for management of uterine corpus cancer in Korea: A Korean Society of Gynecologic Oncology Consensus Statement","volume":"28","author":"Lee","year":"2017","journal-title":"J. Gynecol. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1097\/00000478-199012000-00002","article-title":"Mesonephric remnants, hyperplasia, and neoplasia in the uterine cervix. A study of 49 cases","volume":"14","author":"Ferry","year":"1990","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/PAS.0000000000001193","article-title":"A combined morphologic and molecular approach to retrospectively identify KRAS-mutated mesonephric-like adenocarcinomas of the endometrium","volume":"43","author":"Kolin","year":"2019","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"100652","DOI":"10.1016\/j.gore.2020.100652","article-title":"Molecular profiling of mesonephric and mesonephric-like carcinomas of cervical, endometrial and ovarian origin","volume":"34","author":"Lin","year":"2020","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/PAS.0000000000000958","article-title":"Targeted genomic profiling reveals recurrent KRAS mutations in mesonephric-like adenocarcinomas of the female genital tract","volume":"42","author":"Mirkovic","year":"2018","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1038\/modpathol.2015.103","article-title":"Targeted genomic profiling reveals recurrent KRAS mutations and gain of chromosome 1q in mesonephric carcinomas of the female genital tract","volume":"28","author":"Mirkovic","year":"2015","journal-title":"Mod. Pathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/PAS.0000000000000991","article-title":"Clinicopathologic and molecular characteristics of mesonephric adenocarcinoma arising from the uterine body","volume":"43","author":"Na","year":"2019","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1097\/00000478-199510000-00006","article-title":"Malignant mesonephric neoplasms of the uterine cervix. A report of eight cases, including four with a malignant spindle cell component","volume":"19","author":"Clement","year":"1995","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.21873\/invivo.12079","article-title":"Clinicopathological Characteristics of Squamous Cell Carcinoma and High-grade Squamous Intraepithelial Lesions Involving Endocervical Polyps","volume":"34","author":"Park","year":"2020","journal-title":"In Vivo"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gibbard, E., Cochrane, D.R., Pors, J., Negri, G.L., Colborne, S., Cheng, A.S., Chow, C., Farnell, D., Tessier-Cloutier, B., and McAlpine, J.N. (2020). Whole-proteome analysis of mesonephric-derived cancers describes new potential biomarkers. Hum. Pathol., Online ahead of print.","DOI":"10.1016\/j.humpath.2020.10.005"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1111\/his.12895","article-title":"Hormone receptor-negative, thyroid transcription factor 1-positive uterine and ovarian adenocarcinomas: Report of a series of mesonephric-like adenocarcinomas","volume":"68","author":"McFarland","year":"2016","journal-title":"Histopathology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1097\/PAS.0000000000001142","article-title":"A comparison of GATA3, TTF1, CD10, and calretinin in identifying mesonephric and mesonephric-like carcinomas of the gynecologic tract","volume":"42","author":"Pors","year":"2018","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Pors, J., Segura, S., Chiu, D.S., Almadani, N., Ren, H., Fix, D.J., Howitt, B.E., Kolin, D., McCluggage, W.G., and Mirkovic, J. (2020). Clinicopathologic characteristics of mesonephric adenocarcinomas and mesonephric-like adenocarcinomas in the gynecologic tract: A multi-institutional study. Am. J. Surg. Pathol., Online ahead of print.","DOI":"10.1097\/PAS.0000000000001612"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1097\/PGP.0000000000000088","article-title":"Mesonephric carcinosarcoma involving uterine cervix and vagina: Report of 2 cases with immunohistochemical positivity for PAX2, PAX8, and GATA-3","volume":"33","author":"Roma","year":"2014","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1097\/PGP.0000000000000167","article-title":"Differential expression patterns of GATA3 in uterine mesonephric and nonmesonephric lesions","volume":"34","author":"Roma","year":"2015","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/PGP.0000000000000493","article-title":"Mesonephric adenocarcinoma of the uterine corpus: Report of 2 cases and review of the literature","volume":"38","author":"Zhang","year":"2019","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_21","unstructured":"WHO Classification of Tumours Editorial Board (2020). WHO Classification of Tumours: Female Genital Tumours, IARC."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/PAS.0000000000001401","article-title":"Mesonephric-like carcinoma of the endometrium: A subset of endometrial carcinoma with an aggressive behavior","volume":"44","author":"Euscher","year":"2020","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1007\/s00432-019-03123-7","article-title":"Mesonephric-like adenocarcinomas of the uterine corpus: Report of a case series and review of the literature indicating poor prognosis for this subtype of endometrial adenocarcinoma","volume":"146","author":"Horn","year":"2020","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Choi, S., Joo, J.W., Do, S.I., and Kim, H.S. (2020). Endometrium-Limited Metastasis of Extragenital Malignancies: A Challenge in the Diagnosis of Endometrial Curettage Specimens. Diagnostics, 10.","DOI":"10.3390\/diagnostics10030150"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"188","DOI":"10.4132\/jptm.2019.02.21","article-title":"A Rare Case of Adenosquamous Carcinoma Arising in the Background of IgG4-Related Lung Disease","volume":"53","author":"Choi","year":"2019","journal-title":"J. Pathol. Transl. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Hwang, S., Kim, B.G., Song, S.Y., and Kim, H.S. (2020). Ovarian Gynandroblastoma with a Juvenile Granulosa Cell Tumor Component in a Postmenopausal Woman. Diagnostics, 10.","DOI":"10.3390\/diagnostics10080537"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4132\/jptm.2019.10.24","article-title":"Clinicopathologic characteristics of HER2-positive pure mucinous carcinoma of the breast","volume":"54","author":"Jang","year":"2020","journal-title":"J. Pathol. Transl. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"627","DOI":"10.21873\/cgp.20219","article-title":"Clinicopathological and Molecular Differences Between Gastric-type Mucinous Carcinoma and Usual-type Endocervical Adenocarcinoma of the Uterine Cervix","volume":"17","author":"Jung","year":"2020","journal-title":"Cancer Genom. Proteomics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.21873\/anticanres.13417","article-title":"Targeted Genomic Sequencing Reveals Novel TP53 In-frame Deletion Mutations Leading to p53 Overexpression in High-grade Serous Tubo-ovarian Carcinoma","volume":"39","author":"Jung","year":"2019","journal-title":"Anticancer Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"62","DOI":"10.4132\/jptm.2018.08.30","article-title":"TFE3-Expressing Perivascular Epithelioid Cell Tumor of the Breast","volume":"53","author":"Kim","year":"2019","journal-title":"J. Pathol. Transl. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"813","DOI":"10.21873\/cgp.20235","article-title":"Atypical Mesonephric Hyperplasia of the Uterus Harbors Pathogenic Mutation of Kirsten Rat Sarcoma 2 Viral Oncogene Homolog (KRAS) and Gain of Chromosome 1q","volume":"17","author":"Kim","year":"2020","journal-title":"Cancer Genomics Proteomics"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.21873\/invivo.11628","article-title":"Targeted Sequencing of Tubo-ovarian and Peritoneal High-grade Serous Carcinoma With Wild-type p53 Immunostaining Pattern","volume":"33","author":"Kim","year":"2019","journal-title":"In Vivo"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2933","DOI":"10.21873\/anticanres.14271","article-title":"Primary Peritoneal High-grade Serous Carcinoma Misinterpreted as Metastatic Breast Carcinoma: A Rare Encounter in Peritoneal Fluid Cytology","volume":"40","author":"Park","year":"2020","journal-title":"Anticancer Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1097\/PAS.0b013e3181ac35f5","article-title":"Utility of p16 expression for distinction of uterine serous carcinomas from endometrial endometrioid and endocervical adenocarcinomas: Immunohistochemical analysis of 201 cases","volume":"33","author":"Yemelyanova","year":"2009","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_35","first-page":"6697","article-title":"TP53 Mutation Status of Tubo-ovarian and Peritoneal High-grade Serous Carcinoma with a Wild-type p53 Immunostaining Pattern","volume":"37","author":"Na","year":"2017","journal-title":"Anticancer Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1186\/s13059-019-1848-3","article-title":"Pharmacogenomic analysis of patient-derived tumor cells in gynecologic cancers","volume":"20","author":"Sa","year":"2019","journal-title":"Genome Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/GCO.0b013e328334d8a3","article-title":"Uterine papillary serous carcinoma: Epidemiology, pathogenesis and management","volume":"22","author":"Fader","year":"2010","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/PGP.0000000000000243","article-title":"TP53 Mutational Spectrum in Endometrioid and Serous Endometrial Cancers","volume":"35","author":"Schultheis","year":"2016","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/PAI.0b013e3181e78ff8","article-title":"The utility of PAX-2 and renal cell carcinoma marker immunohistochemistry in distinguishing papillary renal cell carcinoma from nonrenal cell neoplasms with papillary features","volume":"18","author":"Sharma","year":"2010","journal-title":"Appl. Immunohistochem. Mol. Morphol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1136\/jmg.2009.073429","article-title":"TP53 germline mutation testing in 180 families suspected of Li-Fraumeni syndrome: Mutation detection rate and relative frequency of cancers in different familial phenotypes","volume":"47","author":"Ruijs","year":"2010","journal-title":"J. Med. Genet."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4230","DOI":"10.1038\/sj.onc.1203758","article-title":"Novel p53 splice site mutations in three families with Li-Fraumeni syndrome","volume":"19","author":"Verselis","year":"2000","journal-title":"Oncogene"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1038\/modpathol.2013.113","article-title":"Toward standard HER2 testing of endometrial serous carcinoma: 4-year experience at a large academic center and recommendations for clinical practice","volume":"26","author":"Buza","year":"2013","journal-title":"Mod. Pathol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1200\/JCO.2017.76.5966","article-title":"Randomized Phase II Trial of Carboplatin-Paclitaxel Versus Carboplatin-Paclitaxel-Trastuzumab in Uterine Serous Carcinomas That Overexpress Human Epidermal Growth Factor Receptor 2\/neu","volume":"36","author":"Fader","year":"2018","journal-title":"J. Clin. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/4\/717\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:49:23Z","timestamp":1760161763000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/4\/717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,18]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["diagnostics11040717"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11040717","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,18]]}}}