Primary choriocarcinoma metastasizing to skeletal muscles, presenting as an abdominal wall mass: A rare presentation

Epithelioid trophoblastic tumor (ETT) is a rare chemoresistant gestational trophoblastic neoplasm that typically presents as an intrauterine lesion. To our knowledge, no isolated abdominal wall ETT around a Cesarean scar has been reported. Here we describe a 54-yr-old woman with a complex obstetric history who presented with a solitary abdominal wall tumor adjacent to the abdominal Cesarean section scar. The tumor demonstrated typical morphologic and immunophenotypic features of ETT. The gestational origin of the tumor was confirmed by microsatellite genotyping. The tumor enlarged despite the patient undergoing multiagent chemotherapy. Whole-exome sequencing was performed to explore the mechanisms underlying chemoresistance. The ATP-binding cassette subfamily B member 1 (ABCB1) 3435CC genotype, and a putative deleterious x-ray cross-complementing group 4 (XRCC4) Ala73Pro mutations were found. In conclusion, ETT may present as a solitary abdominal wall lesion and microsatellite genotyping could facilitate the determination of its gestational origin. More studies are required to provide mechanistic insights into the chemoresistance of ETT.

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Epithelioid Trophoblastic Tumor Around an Abdominal Cesarean Scar: A Pathologic and Molecular Genetic Analysis

Hsiue

Hsu

Tseng

et al. 2017

International Journal of Gynecological Pathology

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

Yang¹,

Li²,

Zhang³

et al. 2020

J Med Case Reports

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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.

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Human Chorionic Gonadotropin (hCG) Testing in Specimens of Tumor and Myometrial Tissues During Surgical Treatment of Gestational Trophoblastic Tumors

Hemida

Arafa

Abdelfattah

et al. 2015

J. Can. Res. Updates

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Background: Gestational trophoblastic tumors originate from trophoblastic tissues and secrete human chorionic gonadotrophin (hCG). Surgical treatment may be a line of treatment of chemoresistant cases. Objective: To evaluate the accuracy of hCG dipsticks in detection of hCG in tissues of trophoblastic tumors and healthy myometrium during surgery of trophoblastic tumors. Methods: We included 19 samples of tumor and apparently healthy myometrial tissues during surgical treatment of 5 cases of gestational trophoblastic tumors. The hCG dipstick was immersed in a solution containing 1x1 cm of tumor or myometrial tissues. The results of the tests were compared to the histopathological results. Results: The mean age of patients were 38.8 years, the mean parity was 3.4. The mean serum B-hCG level was 101,745.6 mu/ml. Except for one specimen in case 5, all results of the hCG dipsticks were concordant with final histopathologic analysis of the specimens. Sensitivity of hCG test was 100% and specificity was 90%. Conclusion: Intraoperative detection of hCG in different tissues and suspicious masses can be considered as simple, rapid, inexpensive, and reliable test. It can be used to detect the trophoblastic nature of tissues if frozen section is not available as some low resource setting countries. We recommend further larger prospective studies to compare the accuracy and reliability of this novel technique and frozen section analysis.

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Primary choriocarcinoma metastasizing to skeletal muscles, presenting as an abdominal wall mass: A rare presentation

Cited by 3 publications

References 5 publications

Epithelioid Trophoblastic Tumor Around an Abdominal Cesarean Scar: A Pathologic and Molecular Genetic Analysis

Epithelioid Trophoblastic Tumor Around an Abdominal Cesarean Scar: A Pathologic and Molecular Genetic Analysis

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

Human Chorionic Gonadotropin (hCG) Testing in Specimens of Tumor and Myometrial Tissues During Surgical Treatment of Gestational Trophoblastic Tumors

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