SALL4 expression in gestational trophoblastic tumors: a useful tool to distinguish choriocarcinoma from placental site trophoblastic tumor and epithelioid trophoblastic tumor

Oyama

J of Obstet and Gynaecol

et al. 2018

Gestational trophoblastic neoplasm (GTN) is a serious morbidity of complete hydatidiform mole with coexistent fetus (CHMCF) and usually develops after termination of pregnancy. Here we report a case of choriocarcinoma derived from CHMCF during pregnancy. A 33-year-old multiparous woman with suspected CHMCF was admitted with a severe cough. Computed tomography revealed multiple lung metastases. Cesarean section and hysterectomy were performed at 31 weeks of gestation on diagnosis of high-risk GTN from International Federation of Gynecology and Obstetrics (FIGO) scoring. A live female infant weighing 1390 g was delivered. Choriocarcinoma was diagnosed from pathological findings. The patient received multi-agent chemotherapy and was discharged on the 40th postoperative day. In conclusion, CHMCF can result in high-risk GTN during pregnancy. For a suspected GTN, diagnosis from FIGO scoring should determine treatment strategy. If patients with CHMCF wish to continue their pregnancy, careful follow-up, including regular chest radiography and ultrasonography, is warranted.

Section: Discussionmentioning

confidence: 85%

Choriocarcinoma with multiple lung metastases from complete hydatidiform mole with coexistent fetus during pregnancy

Oyama

J of Obstet and Gynaecol

et al. 2018

“…Stichelbout et al reported that SALL4 was expressed in all the choriocarcinomas but not in any placental site trophoblastic tumour or epithelioid trophoblastic tumours. The authors concluded that SALL4 can be helpful in distinguishing different types of GTN 39 . Similarly, Miettinen reported that 84% (6 in 7) CCA cases were SALL4 positive and PSTT cases were negative 40 .…”

Section: Discussionmentioning

confidence: 86%

Differential expression of SALL4 in CTCs derived from hydatidiform moles and gestational trophoblastic neoplasms

Feng

Pei

et al. 2020

American J Rep Immunol

Problem To investigate EMT phenotype and SALL4 expression of circulating tumour cells (CTCs) in patients with gestational trophoblastic neoplasm (GTN). Method of study CanPatrol CTC detection system in combination with SALL4 RNA in situ hybridization was used to investigate the profile of CTCs in different types of gestational trophoblastic disease (GTD). Circulating CTCs were phenotyped and annotated with SALL4 expression in 41 GTD patients, including 12 HM and 29 GTN, as well as 22 pregnant volunteers. Results A positive correlation between the number of CTC and serum β‐hCG concentration was found among the GTN patients. The number of E/M‐CTC was positively correlated with serum β‐hCG, while M‐CTC was positively correlated with prognostic score. Comparison among malignant GTD, benign GTD and healthy pregnant women revealed a significant difference in the number of total CTC, E/M‐CTC, and M‐CTC but not in E‐CTC. ROC analysis was conducted to evaluate the performance of CTC phenotypes in distinguishing GTD patients from healthy pregnant women yielding an AUC as 0.826. Youden's index was maximal at the cutoff value of 8.5/4 mL with sensitivity and specificity at 53.66% and 100%, respectively. SALL4 expression was evaluated in GTD patients with CTC count greater than cutoff value. SALL4 high expressing CTCs (>2 signal dots) were detected in 66.67% (10/15) of malignant GTD patients but not in benign patients (0/5). Conclusion Differential expression of SALL4 was seen in CTCs derived from hydatidiform moles and GTN. CTC profiling may be developed as an adjunct marker to diagnose GTN.

“…While necrosis and eosinophilic hyaline-like material are distinctive features of ETT. [11] They have similar clinical behavior, such as low serum hCG titer, resistant to conventional chemotherapy. Whole-exome sequencing and immunochemistry outcomes show they have different morphologic and immunohistochemical features.…”

Section: Discussionmentioning

confidence: 99%

Extrauterine epithelioid trophoblastic tumors presenting as lung mass

Li¹,

Hu²,

Shi

et al. 2019

Medicine

Rationale: Extrauterine epithelioid trophoblastic tumors (ETT) is a rare variant of gestational trophoblastic neoplasms. Here we aim to learn more clinical and pathological characteristics of ETT patient with an isolated pulmonary mass without uterine lesions, through a rare case of extra-uterine ETT and 7 cases published in English periodicals literature. Patient concerns: A 31-year-old Chinese woman, presented with low-level elevation of serum human chorionic gonadotropin (HCG) for more than 2 years without abnormal symptoms. Dilation and curettage (D&C) was performed and histopathology revealed a secretory phase of endometrium. Chest computed tomography (CT) scan showed a 0.8 cm nodular lesion in the upper left lobe. Then a thoracotomy with left upper lobe segmentectomy was performed. Diagnosis: After pathological and immunohistochemistry diagnosis, the case was confirmed as ETT (III). Interventions: According to FIGO guideline, the patient took 3 cycles of multivalent chemotherapy consisting of cisplatin and etoposide, alternating with etoposid, methotrexate dactinomycin (EP-EMA). Outcomes: The patient had no obvious signs of recurrence after 13 months of follow-up. Lessons: When a fertile age woman persistently shows abnormal low-level escalation of HCG, ETT should be taken into consideration, especially lung X-ray or CT showing lesions without apparent abnormality of the uterus.