Coexisting Epithelioid Trophoblastic Tumor and Placental Site Trophoblastic Tumor During Asymptomatic Relapse: A Case Report and Literature Review

Aiob, Ala; Cohen, Hector; Naskovica, Karina; Tendler, Renee; Sharon, Avishalom; Bornstein, Jacob

doi:10.1097/pgp.0000000000000810

Cited by 4 publications

(1 citation statement)

References 16 publications

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“…To date, it remains unclear whether the malignant lesions were concomitant to APSN, meaning that the specimen leading to the APSN diagnosis might represent a sub-diagnostic partial sampling of a more significant associated lesion or represent a subsequent malignant transformation of APSN to PSTT/ETT. Recent case report has supported the putative link between APSN and ETT/PSTT [63, 64].…”

Section: Atypical Placental Site Nodule (Apsn)mentioning

confidence: 99%

The Rare of the Rarest: Placental Site Trophoblastic Tumor, Epithelioid Trophoblastic Tumor, Atypical Placental Site Nodule

Marquina,

Szewczyk,

Goffin

2024

Gynecol Obstet Invest

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Background ETT and PSTT are two of the rarest GTN that share certain features at diagnosis and management. APSN is a relatively new entity considered as a premalignant lesion. Objectives and Methods The aim of this review is to summarize the main characteristics of each of these entities, their diagnostic features and their treatment’s standard of care including fertility sparing treatments. Outcome A thorough review of ETT, PSTT and APSN. Conclusions The reader will gain an insight view of these rare tumors arising from the intermediate trophoblast.

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Section: Atypical Placental Site Nodule (Apsn)mentioning

confidence: 99%

The Rare of the Rarest: Placental Site Trophoblastic Tumor, Epithelioid Trophoblastic Tumor, Atypical Placental Site Nodule

Marquina,

Szewczyk,

Goffin

2024

Gynecol Obstet Invest

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Epithelioid trophoblastic tumor with lung metastasis: A case report and literature review

Li,

Du,

et al. 2024

Medicine

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Rationale: Epithelioid trophoblastic tumor (ETT) is an extremely rare variant of gestational trophoblastic neoplasms (GTNs). The biological behavior and therapeutic schedule of ETT remains to be defined which frequently poses diagnostic and therapeutic challenges. Although ETT is a relatively indolent malignancy tumor, the therapeutic efficacy and survival rate decrease significantly when presented with metastases. The lung is the most common site of ETT metastasis. Patient concerns: A 39-year-old female patient presented with irregular vaginal bleeding and slight distention pain in lower abdomen. Diagnoses: The patient was diagnosed ETT with lung metastasis after surgery and immunohistochemical staining. Interventions: A total abdominal hysterectomy plus bilateral salpingectomy and histopathology were performed. The patient received 3 cycles of etoposide, methotrexate, actinomycin-D/etoposide, cisplatin (EMA/EP) regimen chemotherapy after surgery. Due to the presence of lung metastasis, she received pulmonary lesion resection and another cycle of postoperative chemotherapy. Outcomes: The patients showed a good response to treatment initially. However, the patient did not complete the full initial treatment for family reasons and had signs of recurrence after 2.5 months. The serum β-hCG level gradually elevated and the lung imaging showed that the lesion area gradually expanded. After 15 months of follow-up, the patient declined further treatment due to a lack of presenting symptoms. Lessons: The diagnosis of ETT should be taken into consideration in patients with abnormal vaginal bleeding and low levels of β-hCG. Patients with metastatic disease should be treated with complete surgical resection and intensive combination chemotherapy to maximize the opportunity for cure. Targeted biological agents might be potential therapeutic strategies for chemotherapy-resistant or recurrent patients.

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Mixed Gestational Trophoblastic Tumors—Challenging Clinicopathological Presentations

Niu,

Buza,

Hui

2024

International Journal of Gynecological Pathology

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Mixed gestational trophoblastic tumors are exceptionally rare and have variable clinicopathological presentations. We report 3 such tumors with different combinations of choriocarcinoma (CC), placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). The patients’ age ranged from 38 to 44 years. Mixed trophoblastic tumor was not considered at the initial diagnosis and all 3 tumors were proven of gestational origin by DNA genotyping. Patient #1 presented with serum human chorionic gonadotropin (hCG) of 97 mIU/mL and a 5.6-cm cervical mass that was initially interpreted as PSTT on biopsy. Hysterectomy revealed a mixed PSTT (60%) and ETT (40%) with extrauterine metastases of only the ETT component. The tumor recurred 15 months after a multiagent chemotherapy and was tested positive for programmed death-ligand 1. The patient received immune checkpoint inhibitor therapy and remained disease-free after 24 months. Patient #2 presented with vaginal bleeding and serum hCG of 46,458 mIU/mL. An endometrial biopsy was interpreted as CC. Recurrence developed in the uterus and lung after methotrexate-based chemotherapy. A mixed CC and ETT were eventually diagnosed upon consultation review. Patient #3 presented with a complete hydatidiform mole and serum hCG of 744,828 mIU/mL. Three months after methotrexate, followed by actinomycin D therapy, a uterine mass was found. Hysterectomy revealed a mixed CC and PSTT. In conclusion, the rarity, elusive presentation, and wide range of histology make the diagnosis of mixed trophoblastic tumors highly challenging. The clinical management and prognosis are dictated by each component of the tumor. CC component must be considered when the patient presents with a high serum hCG level.

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Coexisting Epithelioid Trophoblastic Tumor and Placental Site Trophoblastic Tumor During Asymptomatic Relapse: A Case Report and Literature Review

Cited by 4 publications

References 16 publications

The Rare of the Rarest: Placental Site Trophoblastic Tumor, Epithelioid Trophoblastic Tumor, Atypical Placental Site Nodule

The Rare of the Rarest: Placental Site Trophoblastic Tumor, Epithelioid Trophoblastic Tumor, Atypical Placental Site Nodule

Epithelioid trophoblastic tumor with lung metastasis: A case report and literature review

Mixed Gestational Trophoblastic Tumors—Challenging Clinicopathological Presentations

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