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

Abstract

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.

A Rare Case of Epithelioid Trophoblastic Tumor Presenting as Hematoma of a Caesarean Scar in the Lower Uterine Segment

“…One of the most recent reports of ETT in a 44-year old patient summarized only eight cases of uterine ETT with a normal values of serum βhCG [13]. Among these cases, the interval to antecedent pregnancy ranged from 1 to 30 years [13], significantly longer than an interval of eight months in our presentation. The eight month interval from the preceding pregnancy until the diagnosis of ETT in our case appears the be one of the shortest reported periods between the gestational event and the tumor diagnosis.…”

“…Serum βhCG, the most commonly used diagnostic tool for gestational trophoblastic neoplasia, is often only moderately elevated in the cases of ETT, with a range of 665-2500 mIU/mL [4]. One of the most recent reports of ETT in a 44-year old patient summarized only eight cases of uterine ETT with a normal values of serum βhCG [13]. Among these cases, the interval to antecedent pregnancy ranged from 1 to 30 years [13], significantly longer than an interval of eight months in our presentation.…”

Epithelioid Trophoblastic Tumor—A Challenge to Manage due to Its Rare Existence: A Case Report with Review of Literature

“…Elevated β-hCG is seen in 69% of cases and the levels are mostly < 2,500 mIU/mL unlike in choriocarcinoma where it is very high (>10,000 mIU/mL). 3 There have been few cases reported where the β-hCG levels were normal, 4 and it becomes difficult to use it for follow-up unlike in choriocarcinoma. The diagnosis of ETT is based on microscopy and IHC.…”

"The Trailing Fecundation Epithelioid Trophoblastic Tumour"

“…A typical placental site nodule which discovered incidentally and characteristically displays moderate to severe cytological atypia of the trophoblastic tissue. A borderline Ki-67 nuclear labelling index of up to 10% is observed [17,18].…”

“…Enveloping stroma can be desmoplastic or invaded by inflammatory cells. Foci of stromal dehiscence or desmoplastic reaction can be observed [17,18]. Superficial stromal invasion or lymphoid and vascular invasion may be delineated.…”