Epithelioid trophoblastic tumor presenting as a Caesarean scar defect: A case report

Black, Kristin A.; Simone, Kristen; Hirt-Walsh, Cassandra; Sabourin, Jeanelle

doi:10.1016/j.gore.2021.100715

Cited by 6 publications

(17 citation statements)

References 14 publications

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“…Trauma to the continuity and integrity of the uterine tissue after surgical incision and wound healing in the lower uterine segment may be associated with the development of ETT, and this may be part of the reason why ETTs appear in the lower uterine segment and cervical canal. There have been reports of ETT occurring at and around the uterine incision scar[ 10 , 11 ]. 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[ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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

Yuan¹,

Hao²,

Pan³

et al. 2023

World J Clin Cases

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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.

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Section: Discussionmentioning

confidence: 99%

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

Yuan¹,

Hao²,

Pan³

et al. 2023

World J Clin Cases

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“…They are both relatively resistant to chemotherapy; therefore, the International Federation of Gynecology and Obstetrics (FIGO) risk scoring system is not associated with outcomes in PSTT or ETT. ETT usually presents in the lower uterine segment or cervix, resulting in a potential misdiagnosis of cervical squamous cell carcinoma, while PSTT is a typical tumor of the uterine corpus ( 4 , 8 – 10 ). Pathologically, PSTT has a sheet-like and infiltrative growth pattern, while ETT has been shown to present with smaller, more monomorphic cells and a nested, well-circumscribed nodular growth pattern often with areas of necrosis ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

A Multicenter Retrospective Study of Epithelioid Trophoblastic Tumors to Identify the Outcomes, Prognostic Factors, and Therapeutic Strategies

et al. 2022

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BackgroundThere is no consensus for the management of epithelioid trophoblastic tumor (ETT) up to date.ObjectiveETT is the rarest form of gestational trophoblastic neplasia (GTN). Our goal was to assess the outcomes and explore the prognostic factors of patients with ETT through this multicenter retrospective analysis and to devise a risk-adapted approach to clinical management.MethodsA total of 31 patients were validated as ETT pathologically between January 2004 and June 2021 from three tertiary hospitals. We retrospectively analyzed the characteristics, treatments, outcomes, and prognostic factors.ResultsEight patients experienced a recurrence, and 6 patients died of ETT, resulting in a mortality rate of 19.4%. Five patients with stage I disease had a fertility-preserving treatment. Among them, one patient had a full-term delivery, whereas a 23-year-old patient who declined a hysterectomy died of a recurrent disease. Eight patients of extrauterine ETT with isolated pulmonary lesion were at a young age at diagnosis (median: 30.5 vs. 41, p = 0.003) and had a smaller tumor size (median: 2.4 vs. 4.8 cm, p = 0.003) compared with other patients who had a metastatic disease, and none of them died. The multivariate analyses showed that the number of metastases ≥3 [hazard ratio (HR), 28.16, p = 0.003] was the only significant predictor associated with adverse overall survival, while the number of metastases ≥3 (HR 9.59, p = 0.005) and chemotherapy alone (HR 16.42, p = 0.001) were associated with adverse recurrence-free survival. Patients in stage I or with number of metastases <3 had a favorable prognosis, whereas the prognosis of patients whose number of metastases ≥3 remains poor.ConclusionsChemotherapy alone is insufficient for patients with ETT. Surgical procedures are the mainstay of management for ETT patients. Combined surgery and multi-agent chemotherapy are recommended for patients with metastatic disease and localized disease with persistently positive human chorionic gonadotrophin levels after surgery. The number of metastases at ≥3 is the most critical risk factor for ETT.

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“…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]. This patient presented with transfusion-requiring vaginal bleeding, two months after suction evacuation for retained conception products, along with negative tumor markers [6]. Our patient had a mild vaginal discharge and irregular bleeding of minimal intensity.…”

Section: Discussionmentioning

confidence: 51%

“…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]. This patient presented with transfusion-requiring vaginal bleeding, two months after suction evacuation for retained conception products, along with negative tumor markers [6].…”

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 93%

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

Aničić

Rakic²,

Maglic

et al. 2021

Medicina

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Epitheliod trophoblastic tumor (ETT) account for only 1–2% of all the cases of gestational trophoblastic neoplasia (GTN), with a reported mortality rate of 10–24%. ETT is derived from chorionic type intermediate trophoblastic cells, which appears to be the reason for the only slightly elevated βhCG levels in these patients. We present a case of a 42-year-old patient who was admitted to the clinic eight months after Caesarean delivery, for irregular vaginal bleed with normal values of beta-human chorionic gonadotropin (βhCG). A 6 × 5 cm hematoma was evacuated from the isthmic uterine segment during the operation, and the histopathological exam of the tissue surrounding the hematoma revealed ETT. There were no metastatic lesions on the thoracal, abdominal, and pelvic CT. The second ultrasonographic exam revealed tumefaction of 5 cm at the site from the previous surgical procedure. Color Doppler imaging revealed no central nor peripheral blood flow. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy without adjuvant chemotherapy. This appears to be one of the shortest intervals from the anteceded gestational event until the diagnosis of this tumor, along with the absence of the significant ultrasonographic feature of the ETT-peripheral Doppler signal pattern. We underline that, even with normal values of βhCG, irregular vaginal bleeding following the antecedent gestational event should always arouse suspicion of GTN.

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Epithelioid trophoblastic tumor presenting as a Caesarean scar defect: A case report

Abstract: Highlights Malignancy should be considered as a possible cause of a Caesarean scar defect. Gestational trophoblastic neoplasia can be present despite negative hCG. Limited evidence on fertility-sparing treatment of epithelioid trophoblastic tumor.

Cited by 6 publications

References 14 publications

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

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

A Multicenter Retrospective Study of Epithelioid Trophoblastic Tumors to Identify the Outcomes, Prognostic Factors, and Therapeutic Strategies

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

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