Uterine Epithelioid Trophoblastic Tumor

Abstract Background Mixed gestational trophoblastic neoplasms are extremely rare and comprise a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors, and placental site trophoblastic tumors. We present a case of a patient with extrauterine mixed gestational trophoblastic neoplasm adjacent to the abdominal wall cesarean scar. On the basis of a literature review, this type of case has never been reported before due to the unique lesion location and low incidence. Case presentation Our patient was a 39-year-old Chinese woman who had a history of two cesarean sections and one miscarriage. She had a recurrent anterior abdominal wall mass around her cesarean scar, and the mass was initially suspected of being choriocarcinoma of unknown origin. The patient had concomitant negative or mildly increased serum β-human chorionic gonadotropin at follow-up and no abnormal vaginal bleeding or abdominal pain. However, she underwent local excision twice and had two courses of chemotherapy with an etoposide and cisplatin regimen. She finally opted for exploratory laparotomy with abdominal wall lesion removal, subtotal hysterectomy, bilateral salpingectomy, and left ovarian cyst resection, which showed the abdominal wall lesion, whose components were revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors and 10% choriocarcinomas from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar. Conclusions It is worth noting whether epithelioid trophoblastic tumor exists in the setting of persistent positive low-level β-human chorionic gonadotropin. More studies are required to provide mechanistic insights into these mixed gestational trophoblastic neoplasms.

Download Full-text

Epithelioid trophoblastic tumor of uterus presenting as an ovarian mass: A diagnostic and therapeutic dilemma

Indian Journal of Pathology and Microbiology ◽

10.4103/0377-4929.41669 ◽

2008 ◽

Vol 51 (2) ◽

pp. 242 ◽

Cited By ~ 11

Author(s):

Tanuja Shet ◽

Mahendra Parage ◽

Amita Maheshwari ◽

Reena Nair ◽

Sudeep Gupta ◽

...

Keyword(s):

Ovarian Mass ◽

Trophoblastic Tumor ◽

Epithelioid Trophoblastic Tumor

Download Full-text

Uterine Epithelioid Trophoblastic Tumor in a 44-Year-Old Woman: A Diagnostic Dilemma

Clinics and Practice ◽

10.3390/clinpract11030078 ◽

2021 ◽

Vol 11 (3) ◽

pp. 631-639

Author(s):

Maria-Gabriela Aniţei ◽

Diana-Elena Lazăr ◽

Raluca Alina Pleşca ◽

Cristina Terinte ◽

Radu Iulian ◽

...

Keyword(s):

Reproductive Age ◽

Diagnostic Challenge ◽

Diagnostic Dilemma ◽

Natural Childbirth ◽

Trophoblastic Tumor ◽

Epithelioid Trophoblastic Tumor ◽

Uterine Curettage ◽

Normal Human ◽

Poorly Differentiated ◽

Β Hcg

Background: Epithelioid trophoblastic tumor (ETT) is a rare and newly defined disease, which most commonly occurs in women of reproductive age and can be a sequela of any gestational event. ETT can be present in both intrauterine and extrauterine sites. Case report: A woman of reproductive age, without specific comorbidities and with a single pregnancy and natural childbirth eight years ago, was diagnosed initially with poorly differentiated pleomorphic leiomyosarcoma on the hemostatic uterine curettage. Conclusion: Our case highlights that ETT presents a diagnostic challenge due to its rarity and histologic resemblance to other pathologies. Misdiagnosis delays effective treatment and affects survival. To date, only 8 cases of ETT of the uterus without previous gestational event and normal human chorionic gonadotropin (β-HCG) levels in a 60-year literature survey have been reported.

Download Full-text

Laparoscopic diagnosis and treatment of an isolated epithelioid trophoblastic tumor in recto-uterine pouch

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.13593 ◽

2018 ◽

Vol 44 (5) ◽

pp. 960-965 ◽

Cited By ~ 4

Author(s):

Fang Jiang ◽

Yang Xiang ◽

Li-na Guo

Keyword(s):

Diagnosis And Treatment ◽

Trophoblastic Tumor ◽

Epithelioid Trophoblastic Tumor

Download Full-text

Epithelioid Trophoblastic Tumor: Review of a Rare Neoplasm of the Chorionic-Type Intermediate Trophoblast

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-1875-ettroa ◽

2006 ◽

Vol 130 (12) ◽

pp. 1875-1877

Author(s):

Kimberly H. Allison ◽

Jason E. Love ◽

Rochelle L. Garcia

Keyword(s):

Gestational Trophoblastic Disease ◽

Reproductive Age ◽

Placental Lactogen ◽

Variable Expression ◽

Trophoblastic Tumor ◽

Trophoblastic Cells ◽

Epithelioid Trophoblastic Tumor ◽

Positive Immunostaining ◽

Nodular Growth ◽

Type Intermediate

Abstract We present a brief review of epithelioid trophoblastic tumor, a rare trophoblastic neoplasm derived from chorionic-type intermediate trophoblastic cells that typically presents in reproductive-age women between 1 and 18 years following a previous gestation. Histologic features include a nodular growth pattern of monomorphic, epithelioid cells within a hyaline matrix. Areas of necrosis and mitotic activity (0–9 mitoses per 10 high-power fields) are additional features of this neoplasm. Positive immunostaining for p63 and cytokeratin, frequent location in the lower uterine segment and endocervix, as well as the epithelioid appearance can lead to confusion with squamous cell carcinoma. Inhibin-α is typically expressed, as well as focal, more variable expression of other trophoblastic markers including β-human chorionic gonadotropin, human placental lactogen, placental alkaline phosphate, and Mel-CAM (CD148). The clinical behavior of this rare form of gestational trophoblastic disease is difficult to predict. Although most cases follow a benign course following resection, there is a potential for metastatic disease.

Download Full-text

Extrauterine Epithelioid Trophoblastic Tumor (ETT) Arising from an Antecedent Undiagnosed Molar Pregnancy Presenting as an Adnexal mass: A Case Report

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.164 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S78-S78

Author(s):

J Gallardo ◽

K Hummel ◽

K McCluskey ◽

R Masand ◽

J Sunde

Keyword(s):

Case Report ◽

Tumor Cells ◽

Dna Fingerprinting ◽

Adnexal Mass ◽

Molar Pregnancy ◽

Fingerprinting Analysis ◽

Trophoblastic Tumor ◽

Eosinophilic Cytoplasm ◽

Epithelioid Trophoblastic Tumor ◽

Β Hcg

Abstract Introduction/Objective Epithelioid trophoblastic tumor (ETT) is an extremely rare neoplasm derived from chorionic type intermediate trophoblast. ETT usually follows an antecedent term pregnancy but can also follow spontaneous abortions or molar pregnancy. ETT most often arises from the endometrium, followed by the cervix. Extrauterine ETT are extremely rare, with few cases reported in literature. Methods/Case Report A 41-year-old woman with three term pregnancies presented with abdominal pain, ten years after her last pregnancy. Imaging findings of a 3.5 cm adnexal mass coupled with an elevated serum β-hCG (~ 900 mIU/ml), led to the suspicion of an ectopic pregnancy. Hysterectomy with salpingectomy revealed a 4.7 cm, tan- yellow, necrotic mass in the adnexal region abutting but distinct from the uterine serosa. Histologic evaluation showed a well- circumscribed tumor with pushing borders. The tumor cells were epithelioid with well-defined eosinophilic cytoplasm, monomorphic nuclei, frequent mitosis, and abundant geographic necrosis. The tumor cells were positive for β-hCG, GATA-3, PLAP and inhibin, with focal weak staining squamous markers p63 and p40. DNA fingerprinting analysis, performed to confirm the diagnosis of ETT, revealed a homozygous tumor with two copies of non-maternal genes indicating that the antecedent index gestation giving rise to the tumor was an undiagnosed hydatidiform mole. Following surgery, serum β-hCG levels were normal and the patient is currently on surveillance. Results (if a Case Study enter NA) NA Conclusion We present an extremely rare case of extrauterine ETT arising from a previously undetected molar pregnancy. The diagnosis should be suspected when a mass is observed at extrauterine sites with elevated β-hCG levels in patients with or without vaginal bleeding. Histologic differential of squamous cell carcinoma needs to be ruled out with immunostains. Due to its rarity and highly variable presentation, this entity remains a diagnostic challenge. DNA fingerprinting analysis demonstrating non-maternal genes can help confirm the diagnosis of ETT.

Download Full-text