Coexisting epithelioid trophoblastic tumor and placental site trophoblastic tumor of the uterus following a term pregnancy: report of a case and review of literature

Abstract

Gestational trophoblastic neoplasms are a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors (ETTs), and placental site trophoblastic tumors (PSTTs). Mixed gestational trophoblastic neoplasms are extremely rare. The existence of mixed gestational trophoblastic neoplasms that were composed of choriocarcinoma and/or PSTT and/or ETT was also reported. Herein, we present a case of uterine mixed gestational trophoblastic neoplasm which is ETT admixed with PSTT, and reviewed 9 cases of mixed gestational trophoblastic neoplasms reported in English literature available. The most common combination was a choriocarcinoma admixed with an ETT and/or PSTT. Mixed gestational trophoblastic neoplasms present in women of reproductive age and rare in postmenopausal, Abnormal vaginal bleeding is the most common presenting symptom, serum β-HCG levels are elevated, mostly below 2500 mIU/ml, the tumor was limited to uterus in 7 cases, the rest of 3 with pulmonary metastases at the time of diagnosis. Mixed gestational trophoblastic neoplasms have more similar clinical features with intermediate trophoblastic tumors (ITTs). Total hysterectomy with lymph node dissection is recommended treatment for mixed gestational trophoblastic neoplasms, and chemotherapy should be used in patients with metastatic disease and with nonmetastatic disease who have adverse prognostic factors.

Keywords: Epithelioid trophoblastic tumor; gestational trophoblastic neoplasia; placental site trophoblastic tumor.

Figure 1

A. The tumor consisted of strips and cords of monomorphic intermediate trophoblastic cells with abundant eosinophilic cytoplasm. They were polygonal and pleomorphic, invaded the myometrium in cell cords, dissecting and separating the smooth muscle bundles. B. Immunohistochemistry showed a diffuse positive staining for hPL. C. Negative for p63. D. A focal nodular lesion consisting of relatively uniform epithelioid cells arranged in nests. These tumor cells had distinct cell borders, clear cytoplasm, and relatively uniform round nuclei with fine chromatin. Multinucleated cells were occasionally found. Dense eosinophilic hyaline-like material and necrotic debris surrounding or in the center of neoplastic cells nests. E. Immunohistochemistry showed moderate staining for P63. F. Focal positive or negative for hPL.