Metastatic Epithelioid trophoblastic tumor in lymph nodes: Case report

Document Type : Case report

Authors

1 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.

2 Assistant Professor, Department of Oncologic Gynecology, Vali-Asr hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

3 Associate Professor, Department of Oncologic Gynecology, Vali-Asr hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

4 Assistant Professor, Department of Pathology, Cancer Institute, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

5 Assistant Professor, Department of Midwifery, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnourd, Iran.

Abstract

Introduction: Epithelioid trophoblastic tumor (ETT) is a kind of trophoblastic tumors that is arising from placenta. Since it is extremely rare, estimation of its prevalence is difficult. Involvement of lower uterine segment and cervix in this tumor is unique when compared with other types of trophoblastic tumors. ETT is similar to placental site trophoblastic tumors (PSTTs), in terms of growing slowly, producing low levels of HCG and resistance to chemotherapy. Optimal surgery is always the first and the best approach. In this article, an extremely rare case of metastatic ETTs in the lymph nodes is reported.
Case presentation: A 49 year old women G3L3 presented with menorrhagia in recent 4 months and being severe, she underwent emergency curettage. Pathology report was pregnancy products. Because of exaggerated vaginal bleeding and plateaued hcg levels (40MIU/MIL), hysterectomy was performed. Pathology report was ETT.
Conclusion: Abnormal vaginal bleeding can be the signs of normal or abnormal pregnancy and it is necessary to check hcg level. ETT is usually associated with misdiagnosis or delay in diagnosis which leads to mismanagement of the disease and reducing its survival. Therefore, in diagnosis of molar diseases, regarding to resistance to chemotherapy, the best surgical approach should be performed for the patient.

Keywords

References

  1. Cunningham FG, Kenneth J, Bloom SL, Spong CY, Dash JS, Hoffman BL, et al. Williams obstetrics. 24nd ed. New York: McGraw-Hill; 2014.
  2. Kumar V, Abbas A, Aster J. Robbins basic pathology e-book. 10nd ed. Elsevier Health Sciences; 2017.
  3. DiSaia P, Creasman W, Mannel R, McMeekin S, Mutch D. Clinical Gynecologic Oncology. 9nd ed. Elsevier Health Sciences; 2017.
  4. Berek JS, Hacker NF. Berek and Hacker's Gynecologic Oncology. Lippincott Williams & Wilkins; 2010.
  5. Gadducci A, Carinelli S, Guerrieri ME, Aletti GD. Placental site trophoblastic tumor and epithelioid trophoblastic tumor: Clinical and pathological features, prognostic variables and treatment strategy. Gynecologic Oncology 2019; 153(3):684-93.
  6. Horn LC, Bilek K. Histologic classification and staging of gestational trophoblastic disease. General & diagnostic pathology 1997; 143(2-3):87-101.
  7. Fadare O, Parkash V, Carcangiu ML, Hui P. Epithelioid trophoblastic tumor: clinicopathological features with an emphasis on uterine cervical involvement. Mod Pathol 2006; 19(1):75-82.
  8. Shih IM, Kurman RJ. Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma. Am J Surg Pathol 1998; 22(11):1393-403.
  9. Scott EM, Smith AL, Desouki MM, Olawaiye AB. Epithelioid trophoblastic tumor: a case report and review of the literature. Case Reports in Obstetrics and Gynecology 2012; 2012.
  10. Takekawa Y, Yamamoto T, Sakakibara M, Kimura M, Yoshii R, Yamashita Y. Cytologic findings of epithelioid trophoblastic tumor of the uterus: a case report. Acta Cytol 2010; 54(3):345-8.
  11. Allison KH, Love JE, Garcia RL. Epithelioid trophoblastic tumor: review of a rare neoplasm of the chorionic-type intermediate trophoblast. Arch Pathol Lab Med 2006; 130(12):1875-7.
  12. Frijstein MM, Lok CAR, van Trommel NE, Ten Kate-Booij MJ, Massuger LFAG, van Werkhoven E, et al. Management and prognostic factors of epithelioid trophoblastic tumors: Results from the International Society for the Study of Trophoblastic Diseases database. Gynecol Oncol 2019; 152(2):361-367.
  13. Patel T, Oldan J. Imaging of Metastatic Epithelioid Trophoblastic Tumor With 18F-FDG PET/CT. Clin Nucl Med 2018; 43(6):e200-e202.
  14. Zhang X, Lü W, Lü B. Epithelioid trophoblastic tumor: an outcome-based literature review of 78 reported cases. Int J Gynecol Cancer 2013; 23(7):1334-8.
  15. Eysbouts YK, Bulten J, Ottevanger PB, Thomas CM, Ten Kate-Booij MJ, van Herwaarden AE, et al. Trends in incidence for gestational trophoblastic disease over the last 20 years in a population-based study. Gynecol Oncol 2016; 140(1):70-5.
  16. Saso S, Haddad J, Ellis P, Lindsay I, Sebire NJ, McIndoe A, et al. Placental site trophoblastic tumours and the concept of fertility preservation. BJOG 2012; 119(3):369-74.
  17. Shen X, Xiang Y, Guo L, Ren T, Feng F, Wan X, et al. Analysis of clinicopathologic prognostic factors in 9 patients with epithelioid trophoblastic tumor. Int J Gynecol Cancer 2011; 21(6):1124-30.
  18. Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C, et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6:vi39-50.
  19. Horowitz NS, Goldstein DP, Berkowitz RS. Placental site trophoblastic tumors and epithelioid trophoblastic tumors: Biology, natural history, and treatment modalities. Gynecol Oncol 2017; 144(1):208-214.
  20. Kageyama S, Kanoto M, Sugai Y, Suto T, Nagase S, Osakabe M, et al. MR Imaging of Uterine Epithelioid Trophoblastic Tumor: A Case Report. Magn Reson Med Sci 2016; 15(4):411-415.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 23, Issue 11
January 2021
Pages 99-105

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