Epithelioid trophoblastic tumor of the lower uterine segment and cervical canal: A case report

Abstract

BACKGROUND Epithelioid trophoblastic tumor (ETT) is the rarest type of gestational trophoblastic tumor (GTT). It has been reported that more than 50% of ETTs arise in the uterine cervix or the lower uterine segment. Here, we report a case of ETT within the lower uterine segment and cervical canal and discuss its manifestations, possible causes, and related influencing factors. CASE SUMMARY A 35-year-old woman (gravida 7, miscarriage 3, induction 2 with 1 being twins, para 2 of cesarean section, live 2), who had amenorrhea for 9 mo after breastfeeding for 22 mo after the last cesarean section, was diagnosed with ETT. The lesion was present in the lower uterine segment and endocervical canal with severe involvement of the anterior wall of the lower uterine segment and the front wall of the lower uterine segment where the cesarean incisions were made. Laboratory tests showed slight elevation of serum beta-human chorionic gonadotropin. Intraoperative exploration showed the presence of a normal-sized uterus body with an enlarged tumor in the lower uterine segment. The surface of the lower uterine segment was light blue, the entire lesion was approximately about 8 cm × 8 cm × 9 cm, with compression and displacement of the surrounding tissue. Histological examination diagnosed ETT. Immunohistochemical analysis showed positive expression of p63, with a Ki-67 proliferation index of 40%. CONCLUSION A search of the PubMed database using the search terms "cesarean section" and "epithelioid trophoblastic tumor" retrieved nine articles, including 13 cases of ETT and ETT-related lesions, all 13 cases had a history of cesarean section, and the lesions were all located at the cesarean section incision on the anterior wall of the lower uterine segment. The present case is the 14th reported case of ETT after cesarean section. Therefore, we deduced that cesarean section trauma had an important effect on the occurrence of ETT at this site.

Primary hepatic metastatic epitheloid trophoblastic tumor of the uterus treated with multimodal therapy including pembrolizumab and thermoablation. Case report of an extremely rare disease and review of the literature

“…Immunohistochemistry, in this case, showed that the ETT tumor cells typically expressed p63 and a Ki-67 nuclear labeling index greater than 10%, this is consistent with literature reports ( Yuan et al, 2023 , Ngan et al, 2021 , Ngan et al, 2018 ).…”

“…The expression of p63 is helpful for the differential diagnosis of ETT and PSTT, as the latter is negative and ETT is positive ( Houghton and McCluggage, 2009 ). Most reports have found a Ki-67 proliferation index greater than 10 % ( Yuan et al, 2023 , Ngan et al, 2021 ).…”

“…5 ) ( Scott et al, 2012 ). Literature reports that ETT tumor cells typically express HCG, inhibin-alpha and p63 ( Yuan et al, 2023 , Brodsky et al, 2022 ). The expression of p63 is helpful for the differential diagnosis of ETT and PSTT, as the latter is negative and ETT is positive ( Houghton and McCluggage, 2009 ).…”