Special epithelioid trophoblastic tumor: A case report

BACKGROUND

Epithelioid trophoblastic tumor (ETT) is a special type of gestational trophoblastic tumor. However, its pathogenesis has been incompletely elucidated. ETT rarely occurs in the ovaries and fallopian tubes, unlike placental site trophoblastic tumor, requiring a histopathological biopsy and immunohistochemistry for further diagnosis.

CASE SUMMARY

A 29-year-old woman with irregular vaginal bleeding and elevated serum chorionic gonadotropin (β-hCG) levels presented similar symptoms to ectopic pregnancy. Transvaginal ultrasound revealed abnormal echoes of the left adnexa. Postoperatively, the pathology of the left ovary and fallopian tube was reported as ETT. The patient was followed up with regular hCG measurements and ultrasounds. The blood hCG values showed an upward trend 3 mo after the operation and then chemotherapy was prescribed. The current health status is normal.

CONCLUSION

For women of childbearing age with elevated serum β-hCG levels, practitioners should consider ETT and be alert to the poor prognosis of the disease. After surgery, the patient's condition should be closely observed to prevent recurrence and metastasis. Postoperative chemotherapy is only helpful for treating the disease to a certain extent.

[Germ cell and sex cord-stromal tumors of the testis : WHO classification 2016]

Earlier revisions of the WHO classification of testicular tumors, which was originally published in 1977, contained only minor additions. In the WHO 2016 classification, in contrast, germ cell tumors are split into two major groups based on their distinct pathohistogenesis, i. e., those which derive from an in situ forerunner lesion and those which do not. The latter category includes prepubertal yolk sac tumors and teratomas, as well as spermatocytic seminoma. The classification of yolk sac tumors and teratomas as arising before or after puberty is also of prognostic value. The group of trophoblastic tumors has also been divided into choriocarcinoma and "nonchoriocarcinomatous trophoblastic tumors," which are rare but may also be clinically significant. The changes in the classification of the sex cord-stromal tumors are not particularly important; rare variants without clinical importance of the single well-known tumors have been omitted. A new entity, a kind of "in situ" large cell Sertoli cell neoplasia, has been introduced.

Circulating Cell Free DNA in the Diagnosis of Trophoblastic Tumors

Gestational trophoblastic neoplasia (GTN) represents a group of diseases characterized by production of human chorionic gonadotropin (hCG). Since non-gestational tumors may occasionally secrete hCG, histopathological diagnosis is important for appropriate clinical management. However, a histopathological diagnosis is not always available. We therefore investigated the feasibility of extracting cell free DNA (cfDNA) from the plasma of women with GTN for use as a “liquid biopsy” in patients without histopathological diagnosis. cfDNA was prepared from the plasma of 20 women with a diagnosis of GTN and five with hCG-secreting tumors of unknown origin. Genotyping of cfDNA from the patient, genomic DNA from her and her partner and DNA from the tumor tissue identified circulating tumor DNA (ctDNA) (from 9% to 53% of total cfDNA) in 12 of 20 patients with GTN. In one case without a tissue diagnosis, ctDNA enabled a diagnosis of GTN originating in a non-molar conception and in another a diagnosis of non-gestational tumor, based on the high degree of allelic instability and loss of heterozygosity in the ctDNA. In summary ctDNA can be detected in the plasma of women with GTN and can facilitate the diagnosis of both gestational and non-gestational trophoblastic tumors in cases without histopathological diagnosis.

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Circulating tumor DNA can be detected in the plasma of patients with gestational trophoblastic neoplasia.

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Analysis of circulating tumor DNA may provide a diagnosis in patients with hCG-secreting tumors and no tissue biopsy.

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ctDNA may provide a source of tumor DNA for further investigation of gestational trophoblastic neoplasia.

Gestational trophoblastic neoplasia describes a group of pregnancy related cancers. These cancers produce the pregnancy hormone human chorionic gonadotropin (hCG) which is useful in diagnosing and monitoring the disease. Some non-pregnancy related cancers may also make hCG causing difficulty with diagnosis in patients without a biopsy for pathological diagnosis.

In this study we detected DNA from the cancer in patients' blood. Analysis of this DNA enabled us to distinguish cancers that were pregnancy related from those that were not. In the future we may use this technology to help diagnose pregnancy related cancers in patients where a biopsy is unavailable.

[Incidental intraplacental gestational choriocarcinoma on a full-term placenta]

Of all the gestational trophoblastic tumors, the gestational choriocarcinomas have the worst prognosis and the most uncommon. We report a case diagnosed on a full-term placenta, discovered incidentally. The patient, gravida 2, para 1, delivered a hypotrophic infant at 38 weeks gestation. The placenta was examined in the laboratory to perform anatomo-pathological examination in order to explain the growth retardation. This study revealed the presence of an intraplacental choriocarcinoma. Disease staging was negative for both mother and child, and beta-HCG levels remained at zero. These two factors are rather good prognosis for choriocarcinoma. With this observation, we highlight the added-value of placental examination, which seems essential for any fetal pathology, pathological pregnancy and intrapartum complications. Anatomo-pathological examination must be meticulous and systematized in order to not overlook an intraplacental tumor.

Spontaneous hemoperitoneum from hepatic metastatic trophoblastic tumor

Spontaneous hemoperitoneum (SP) is defined as the presence of blood within the peritoneal cavity that is unrelated to trauma. Although there is a vast array of etiologies for SP, primary hepatocellular carcinoma and hepatic adenoma are considered to be the most common causes. Hepatic metastatic tumor associated with spontaneous rupture is rare. SP from hepatic metastatic trophoblastic tumor may initially present with a sudden onset of abdominal pain. Abdominal computed tomography (CT) plays an important role in establishing the diagnosis of SP, indicating its origin and etiology, and determining subsequent management. Herein, we report an uncommon case of hemoperitoneum from spontaneous rupture of a hepatic metastatic trophoblastic tumor in a young female patient. Interestingly, the contrast-enhanced CT findings demonstrated hypervascular hepatic masses with persistent enhancement at all phases, which were completely different from the common appearances of hepatic metastases. For SP resulting from hepatic metastatic tumors, surgical intervention is still the predominant therapeutic method, but the prognosis is very poor.