Introduction/Background Ovarian mesonephric-like adenocarcinoma (MLA) are rare tumors that can arise from the uterine corpus and the ovary. These tumors share histological features with well-described mesonephric adenocarcinoma (MA) arising in the uterine cervix and vagina. MLA histogenesis is still debated. MA derives from mesonephric ducts remnants of the female genital tract. MLA shares morphologic, immunophenotypic and molecular features with MA nonetheless the association with mesonephric remnants or hyperplasia has yet to be prooved. Increased mitotic activity and tumor cell necrosis appear to have an effect on the aggressive nature of this tumor.

Methodology The objective is to report a case of MLA and its treatment.

Results The patient is a 54 years old female who presented with postmenopausal bleeding associated to a preoperative diagnosis of atypical hyperplasia. A laparoscopic hysterectomy and bilateral salpingo-oophorectomy was performed with no complications. Final pathology report was notable for a MLA of the left ovary. No affection was found in the uterus nor in the contralateral ovary. Due to this finding, complete surgical staging was performed and no pathological affection was reported in the paraaortic lymph nodes, pelvic lymph nodes, omentum, peri-colic gutter biopsies, splenic or hepatic diaphragm biopsies. The patient was staged as an ovarian cancer FIGO IA. Post operative Positron Emission Tomography showed no evidence of hypermetabolic metastatic disease. 4 cycles of adyuvant chemotherapy with carboplatin and liposomol doxorubicin were administered. The patient is currently under surveillance, and has shown no clinical, serological or imaging evidence of relapse.

Conclusion MLA appears to have a very aggressive nature even in early stages. Due to its rarity, there are no available databases on prognosis on ovarian MLA. The optimal treatment remains unclear.