The immunohistochemistry staining by CK7, CAM5.2, 34 beta E12, CEA, C-A125, Leu-M1 and Vimentin (positivity), P53 and Bcl-2 (overexpression) and CK20, [beta]-HCG and Alpha 1-fetoprotein (negative staining) are suggestive for CCC and could distinguish this malignancy from other differential diagnoses such as Aria-Stella reaction, micro glandular hyperplasia, and mesonephric hyperplasia
in adults, and Yolk sac tumor, sarcoma botryoides, and embryonal rhabdomyosarcoma in children, and metastatic renal cell carcinoma in all ages.
(53) A spectrum of benign (mesonephric hyperplasia) to malignant (mesonephric carcinoma) mesonephric proliferations is recognized.
Cervical mesonephric hyperplasia lacks KRAS/NRAS mutations.
(61) In a follow-up study evaluating 10 cases of mesonephric hyperplasias, no activating mutations in KRAS or NRAS were detected.
 Most of the other nonneoplastic lesions such as tunnel clusters, mesonephric hyperplasia
, endometriosis, and microglandular endocervical hyperplasia are not given much importance even though they mimic in situ or malignant neoplasm.
Microscopically, mesonephric hyperplasia area, which is composed of tubular structures, had colloid-like secretions, EMA, complex papillary structures, vast solid structure and clear cell areas (Figure-1).
The histogenetic origin of cervical mesonephric hyperplasia and mesonephric adenocarcinoma of the uterine cervix studied with immunohistochemicalmethods.
Mesonephric adenocarcinoma (endometrioid type) of endocervix with diffuse mesonephric hyperplasia involving cervical wal land myometrium: An unusual case report.
(13) In addition, recent reports have shown that PAX8 is expressed in lesions of Wolffian/ mesonephric origin, including mesonephric remnants, mesonephric hyperplasia
, mesonephric adenocarcinoma, and carcinosarcoma.
(29) Clear cell carcinoma must be distinguished from other tumorlike conditions containing clear cells such as (1) Arias-Stella reaction; (2) microglandular hyperplasia; and (3) mesonephric hyperplasia; as well as (4) carcinomas containing clear cells (squamous cell carcinoma and metastatic clear renal cell carcinoma).
Mesonephric hyperplasia may enter the differential diagnosis of clear cell carcinoma, as it often has tubules and cysts and may have a diffuse and/or extensive growth (may reach cervical surface, lower uterine segment, and upper vagina); focal glandular crowding and nuclear atypia may be seen.
p53 shows focal nuclear positivity ("wild-type" pattern of staining) and less frequently, negativity or diffuse positivity in clear cell carcinoma, (155,279,280,282) while benign lesions, namely, Arias Stella reaction and mesonephric hyperplasia, have been reported to be p53 negative.