Epithelioid trophoblastic tumor coexisting with choriocarcinoma around an abdominal wall cesarean scar: a case report and review of the literature

Abstract

Background Mixed gestational trophoblastic neoplasms are extremely rare and comprise a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors, and placental site trophoblastic tumors. We present a case of a patient with extrauterine mixed gestational trophoblastic neoplasm adjacent to the abdominal wall cesarean scar. On the basis of a literature review, this type of case has never been reported before due to the unique lesion location and low incidence. Case presentation Our patient was a 39-year-old Chinese woman who had a history of two cesarean sections and one miscarriage. She had a recurrent anterior abdominal wall mass around her cesarean scar, and the mass was initially suspected of being choriocarcinoma of unknown origin. The patient had concomitant negative or mildly increased serum β-human chorionic gonadotropin at follow-up and no abnormal vaginal bleeding or abdominal pain. However, she underwent local excision twice and had two courses of chemotherapy with an etoposide and cisplatin regimen. She finally opted for exploratory laparotomy with abdominal wall lesion removal, subtotal hysterectomy, bilateral salpingectomy, and left ovarian cyst resection, which showed the abdominal wall lesion, whose components were revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors and 10% choriocarcinomas from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar. Conclusions It is worth noting whether epithelioid trophoblastic tumor exists in the setting of persistent positive low-level β-human chorionic gonadotropin. More studies are required to provide mechanistic insights into these mixed gestational trophoblastic neoplasms.

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

“…Although ETT was recognized as a distinct GTN entity in 1998 by Shih and Kurman (2), ETTs combined with other gestational trophoblastic have been reported. MGTNs are extremely rare, and a review of English literature revealed that in addition to our case, there are 36 other MGTDs (Table 1) (2)(3)(4)6,(8)(9)(10)(11)(12)(13)(14).…”

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

“…We found only a few reports of ETT presenting as a mass in the Caesarean scar, with two being synchronous with choriocarcinoma [6][7][8][9][10]. Black et al reported a similar case where the patient with three previous Caesarean sections had been diagnosed with ETT after being followed for spontaneous abortion with retained products of conception [6].…”

“…Distinctive of PSTTs, the histological image of ETT shows well-circumscribed, nested growth of smaller cells with less nuclear pleomorphism, often presented with a geographical necrosis pattern. As there are reports of ETT coexisting with PSTT [7], it is necessary to distinguish these two entities histologically. Furthermore, postchemotherapy examined samples of other forms of GTN can present with a histological pattern similar to ETT [17].…”

Special epithelioid trophoblastic tumor: A case report

“…Xing et al [ 3 ] first reported that ETT has a low probability of occurring in the ovary and fallopian tube, simultaneously. The composition of the fallopian tube tumor in our case study is the same as that on the ovary and it may be the metastasis of ovarian ETT, common in women of childbearing age after various pregnancies[ 4 , 5 ]. The patient was 29-years-old in 2015 and due to partial hydatidiform mole surgery, the blood β-hCG value decreased slowly for 3 mo and the uterine cavity presented an abnormal echo.…”