Extrauterine Epithelioid Trophoblastic Tumor Arising in the Ovary With Multiple Metastases

Abstract

Epithelioid trophoblastic tumor is a neoplasm of the chorionic-type intermediate trophoblasts. It is considered a rare gestational trophoblastic disease and is frequently misdiagnosed as carcinoma. Extrauterine epithelioid trophoblastic tumor has been reported in multiple anatomical sites. We report a case of a 50-year-old woman who presented with abdominal pain and distension. Her initial β-human chorionic gonatotropin level was 806.7 IU/L. Imaging showed a large complex ovarian mass with peritoneal and subcapsular hepatic deposits as well as pulmonary nodules. Morphological features of the tumor and its immunohistochemical reactivity to CK8/18, CK7, p63, and CD10 were consistent with the diagnosis of an extrauterine epithelioid trophoblastic tumor arising from the ovary. The differential diagnoses, including other ovarian tumors, were ruled out on the basis of morphology and negative immunostaining to a relatively extended panel of antibodies. A prolonged follow up of these cases and the recognition of such rare tumors in unusual sites are crucial to the diagnosing pathologist and treating physician.

Pseudopapillary and Macrofollicular Microscopic Growth Patterns in an Advanced Stage Ovarian Dysgerminoma: A Case Report

“…In general, based on the characteristic morphologic features, the diagnosis is straightforward. However, it may exhibit different patterns of growth which may cause difficulty to an accurate diagnosis (11,13). This case needs reporting due to its unusual morphological pattern.…”

“…It is highly chemosensitive and responds well to a combination of Cisplatin, Bleomycin and Etoposide (BEP) (12). Due to good prognosis, distinction from other types of ovarian neoplasms is of important value.…”

“…Dysgerminoma accounts for 1-2% of all primary ovarian tumors and is one of the most common types of malignant germ cell neoplasms (3,11).…”

“…Macrofollicule defined as the presence of large, relatively uniform follicles resembling follicle cyst is a typical structure in juvenile granulosa cell tumor, small cell carcinoma or metastatic melanoma (12,13,16). This structure was seen frequently in the microscopic examination of our case, leading to misdiagnosis as granulosa cell tumor by some of our colleagues.…”

“…Distinct cytologic features, lobulated architecture with lymphocytes in the interlobular fibrous septa, and immunohistochemistry are helpful for an accurate diagnosis (5). Pseudoglandular, trabecular and solid tubular microscopic architectures have led to a misdiagnosis of sertoli cell tumors (11,15).…”