Placental site trophoblastic tumour mimicking an intramural pregnancy: a case report and review of the literature
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Abstract:
Gestational trophoblastic disease (GTD) covers a range of proliferative disorders from non-neoplastic hydatid moles to malignant neoplastic conditions such as choriocarcinoma. The incidence of these diseases is low and often challenging to diagnose. Placental site trophoblastic tumour (PSTT) is the rarest form of GTD, accounting for up to 3% of all cases. We present a case of a 35-year-old patient diagnosed with PSTT mimicking an intramural pregnancy. Placental site trophoblastic tumour occurred after pregnancy, which ended as a blighted ovum. β-hCG was not very high, and the patient had no complaints. The diagnosis was made after resection of formation which was accepted for intramural pregnancy. To our knowledge, this is the first such case described in the literature. A hysterectomy performed later confirmed the absence of a residual tumour after conservative intervention. The lack of distant metastases, confirmed by positron emission tomography-computed tomography scan, allowed for only hysterectomy with bilateral salpingo-oophorectomy to be performed. The patient was classified as low risk according to the World Health Organization (WHO) scoring system. Placental site trophoblastic tumour is a rare malignant tumour (despite its WHO coding) from the group of GTDs. It is not presented with a classic clinical picture, and its clinical diagnosis is challenging. However, clinicians should consider it in the case of unclear events after any type of pregnancy.Keywords:
Gestational Trophoblastic Disease
Trophoblastic Tumor
Trophoblastic neoplasm
Abstract The epithelioid trophoblastic tumor is an unusual type of trophoblastic tumor. Herein, we describe a patient with coexisting epithelioid trophoblastic tumor and choriocarcinoma in the uterus. The patient had a history of hydatidiform mole with recurrent elevation of human chorionic gonadotrophin level that is resistant to chemotherapy. Histopathologic and immunohistochemical examination showed distinctive differences between the 2 trophoblastic tumors. The development of epithelioid trophoblastic tumor may be related to the persistence of locally invasive disease, which was unresponsive to chemotherapy. The patient responded well to surgery. The presence of an epithelioid trophoblastic tumor should be considered in chemoresistant gestational trophoblast tumor.
Trophoblastic Tumor
Trophoblastic neoplasm
Trophoblast
Gestational Trophoblastic Disease
Chorioepithelioma
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Gestational trophoblastic disease (GTD) represents a group of disorders that derive from placental trophoblastic tissue, including hydatidiform moles, postmolar gestational trophoblastic neoplasia (GTN), and gestational choriocarcinoma. GTN is the most curable gynecologic malignancy and tends to be more common after a complete molar pregnancy than a partial mole. Human chorionic gonadotropin (β-hCG) represents a marker for GTD and should be followed for 6 months after molar pregnancy evacuation to rule out the development of postmolar GTN. GTN is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation. Classification for GTN as low (score ≤ 6) or high risk (score > 7) is based on the World Health Organization prognostic score. This scoring system helps select treatment, which usually entails actinomycin D or methotrexate for low-risk disease and EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) for high-risk disease. These regimens can achieve cure rates approaching 100% and over 90% for low- and high-risk disease, respectively. This review contains 5 figures, 8 tables and 49 references Key words: choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia, human chorionic gonadotropin, hydatidiform mole, invasive mole
Molar Pregnancy
Gestational Trophoblastic Disease
Human chorionic gonadotropin
Trophoblastic Tumor
Partial Hydatidiform Mole
Trophoblastic neoplasm
Chorioepithelioma
Trophoblast
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Molar pregnancy and gestational trophoblastic neoplasia (GTN) comprise a group of interrelated diseases including complete and partial molar pregnancy, invasive mole, placental-site trophoblastic tumor, and choriocarcinoma, that have varying propensities for local invasion and metastasis. The term gestational trophoblastic disease (GTD) encompasses all of these entities, while GTN refers specifically to the subtypes with the potential for tissue invasion and metastasis. Before the 1950s, the prognosis for these diseases, particularly choriocarcinoma, was poor. In the modern age of chemotherapy, GTN is generally curable, even in cases of advanced disease.
Gestational Trophoblastic Disease
Molar Pregnancy
Trophoblastic neoplasm
Trophoblastic Tumor
Gestational trophoblastic neoplasia
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Gestational Trophoblastic Disease
Trophoblast
Partial Hydatidiform Mole
Trophoblastic neoplasm
Trophoblastic Tumor
Gestational trophoblastic neoplasia
Chorioepithelioma
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The gestational trophoblastic disease summarizes all types of hydatidiform moles, placental site trophoblastic tumor and choriocarcinoma. It is of clinical relevance to distinguish between complete hydatidiform mole and partial hydatidiform mole to predict prognosis of recurrency of molar pregnancy and the risk of the development of malign and metastatic gestational trophoblastic disease. Differential diagnosis of choriocarcinoma versus placental site trophoblastic tumor, carcinoma or sarcoma with low differentiation can cause problems in borderline-cases. The present study investigates the value of immunohistochemistry in the diagnosis of gestational trophoblastic disease.Nine cases of patients with complete hydatidiform mole, 20 cases of partial hydatidiform mole and seven cases of choriocarcinoma were analyzed for the immunohistochemical reaction with antibodies against human choriogonadotropin (hCG), human placental lactogen (hPL). placental alkaline phosphatase (PLAP), cytokeratine and vimentin.Complete hydatidiform mole shows strong expression of hCG and weak expression of PLAP. Weak hCG and strong PLAP expression is found in partial hydatidiform mole. Choriocarcinoma presents strong expression of hCG and weak expression of hPL and PLAP. All tissues show positive reaction with anticytokeratine and negative reaction with anti-vimentin.Our study proves immunohistochemistry as useful tool for differential diagnosis in borderline cases of gestational trophoblastic disease.
Partial Hydatidiform Mole
Gestational Trophoblastic Disease
Human placental lactogen
Trophoblastic Tumor
Placental alkaline phosphatase
Trophoblastic neoplasm
Chorioepithelioma
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Gestational trophoblastic disease is an uncommon group of pregnancy-related disorders, with a course of trophoblastic proliferation, including hydatidiform mole (Agha et al., 2020), invasive and metastatic mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelial trophoblastic tumor. Choriocarcinoma and trophoblastic tumor of the placenta are the most important tumors associated with pregnancy.
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Trophoblastic Tumor
Partial Hydatidiform Mole
Gestational Trophoblastic Disease
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Gestational Trophoblastic Disease (GTD) originates from placental tissue and is among the rare human tumors that can be cured even in the presence of widespread metastases. GTD include a spectrum of interrelated tumors including complete and partial hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumor, that have different propensities for local invasion and spread. Although most GTD develop after a mole, they can follow any antecedent pregnancy.Transvaginal ultrasound, routinary dosage of beta-hCG and current approaches to chemotherapy, let most women with malignant gestational trophoblastic disease to be cured and their reproductive function preserved.
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Molar Pregnancy
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Gestational trophoblastic disease (GTD) is a group of tumors defined by abnormal trophoblastic proliferation. Trophoblast cells produce human chorionic gonadotropin (hCG). GTD is divided into hydatidiform moles (contain villi) and other trophoblastic neoplasms (lack villi). The non-molar or malignant forms of GTD are called gestational trophoblastic neoplasia (GTN). They include the invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These malignancies can occur weeks or years following any pregnancy but occur most commonly after a molar pregnancy.
Gestational Trophoblastic Disease
Molar Pregnancy
Trophoblastic Tumor
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Human chorionic gonadotropin
Partial Hydatidiform Mole
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Chorioepithelioma
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Gestational trophoblastic disease (GTD) is due to the abnormal and uncontrolled proliferation of the trophoblastic cells in a pregnancy. It encompasses a spectrum of conditions from benign hydatidiform mole to invasive mole and malignant choriocarcinoma and the rarer forms of placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). The malignant forms of the disease, i.e. choriocarcinoma, PSTT and ETT, are collectively known as gestational trophoblastic neoplasia (GTN).
Gestational Trophoblastic Disease
Trophoblastic Tumor
Trophoblastic neoplasm
Partial Hydatidiform Mole
Gestational trophoblastic neoplasia
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