Epithelioid Trophoblastic Tumor: Report of Two Cases in Postmenopausal Women with Literature Review and Emphasis on Cytological Findings

Abstract

Background: Epithelioid trophoblastic tumor (ETT) is a rare gestational trophoblastic neoplasm of intermediate trophoblasts. It was first described by Shih and Kurman [Am J Surg Pathol 1998;22:1393-1403] who outlined its clinicopathologic characteristics in 14 cases, establishing it as a distinct entity of gestational trophoblastic tumors. It represents 1.39% of all gestational trophoblastic diseases. Most cases are reported in reproductive-age women following a prior gestation with a time interval between 2 weeks and 30 years. ETT is extremely rare in postmenopausal women. It is commonly misdiagnosed as a squamous cell carcinoma (SCC), poorly differentiated carcinoma or another gestational trophoblastic tumor. Limited data is available regarding its cytological features on Pap smears. Cases: We report 2 cases of uterine ETT occurring in postmenopausal women. In both cases, an initial diagnosis of an SCC and a poorly differentiated carcinoma was rendered. We highlight the features of ETT helpful in differentiating it from other mimickers with emphasis on rarely reported cytological features of this neoplasm. Conclusion: ETT is a rare tumor with characteristic cytological features, but is commonly confused with SCC. A high index of suspicion is needed to make the correct diagnosis or to raise the consideration of ETT, especially in cases with an increased β-human chorionic gonadotropin.

Epithelioid trophoblastic tumor: A single institution case series at the New England Trophoblastic Disease Center

“…Similar to published reports, the patients in this series predominantly presented at reproductive ages with vaginal bleeding. Our series does document two patients who were postmenopausal at presentation as has been rarely described in the literature previously in only four cases [13,15]. The most common antecedent gestation was a full term pregnancy with three of those patients demonstrating an interval greater than four years from the antecedent pregnancy to diagnosis of ETT (mean 15.6 years).…”

MR Imaging of Uterine Epithelioid Trophoblastic Tumor: A Case Report

“…Turning to the shape and macroscopic growth pattern of uterine ETT, it usually presents as a circumscribed mass of various size, the maximum tumor diameter ranged from 0.5 to 14.8 cm, 1 , 15 – 17 but sometimes presents as an invasive growth. Several shapes of ETT have been reported, including solitary nodules of the myometrium, 4 , 7 , 11 , 12 a solid mass replacing the myometrium, 6 polypoid lesions extending into the uterine cavity, 4 , 11 and irregular lesions along cesarean section scars.…”

“…Epithelioid trophoblastic tumor (ETT) is a rare gestational trophoblastic neoplasm of chorionic-type intermediate trophoblasts. 1 In 1998, Shih and Kurman established ETT as a distinct entity within the category of gestational trophoblastic disease. 2 ETT is distinguished from, but may occur in conjunction with, placental site trophoblastic tumor and choriocarcinoma.…”

“…As the neoplastic cells in ETT exhibit an epithelial-like growth pattern with geographic necrosis, ETT is commonly confused, both clinically and pathologically, with squamous cell carcinoma. 1 , 2 , 4 …”

Extrauterine Epithelioid Trophoblastic Tumor Arising in the Ovary With Multiple Metastases

“…There are only 2 cases of ovarian localizations, one of which presented with pulmonary metastases (Table 1). 2,7,[11][12][13][14] Epithelioid trophoblastic tumor exhibits a nodular growth of medium-sized tumor cells arranged in nests or cords to large masses. Deposition of eosinophilic hyalinelike material is characteristically present in the center of tumor nests or between tumor cells.…”