Diagnosing and treating rare lesions in a low resource setting: lessons from a hybrid epithelioid trophoblastic tumor and choriocarcinoma

Patrick K Akakpo,Evans Agbeno,Leonard Derkyi-Kwarteng,Kofi Ulzen-Appiah

doi:10.4314/gmj.v51i4.9

Patrick K Akakpo, Evans Agbeno + Show 2 more

Open Access

https://doi.org/10.4314/gmj.v51i4.9

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Journal: Ghana Medical Journal	Publication Date: Feb 7, 2018
Citations: 3	License type: cc-by

Affiliation: University of Cape Coast

Abstract

To raise awareness of the existence of a rare type of malignant trophoblastic tumor and discuss the diagnostic challenges and management of this lesion in a low resource setting. A 35 -year -old G6P3 woman was referred to our facility on account of persistent vaginal bleeding due to a suspected incomplete miscarriage with a cervical mass. Her serum β-HCG was elevated (36,900 mIU/ml) and examination showed a bleeding cervical mass. An initial histopathological diagnosis of moderately differentiated squamous cell carcinoma was reviewed to epithelioid trophoblastic tumor resulting in an extra-fascial hysterectomy. A final histopathological diagnosis of hybrid Epithelioid Trophoblastic Tumor and Choriocarcinoma (ETT/CC) was made after external review and immunohistochemistry. She received subsequent chemotherapy. Epithelioid trophoblastic tumor and its hybrids are difficult to diagnose. They may be diagnosed as moderately differentiated squamous cell carcinoma especially in low resource settings where cervical squamous cell carcinoma is relatively more common. A high index of suspicion, a serum β HCG test and close collaboration between clinicians and pathologists can help make the diagnosis. None.

Highlights

Gestational trophoblastic diseases (GTD) are characterized by abnormal proliferation of placental trophoblasts and include benign and malignant lesions.[1]The malignant lesions are often referred to as Gestational Trophoblastic Tumours/Neoplasms (GTN).Epithelioid trophoblastic tumor is a rare neoplasm and represents the most recent addition to the gestational trophoblastic tumor category.[2]
Epithelioid Trophoblastic Tumor (ETT) was first characterized in 1998 as a rare form of trophoblastic disease composed of intermediate trophoblasts, cells with features that made it distinct from placental-site trophoblastic tumor (PSTT) and choriocarcinoma (CC).[3]
Hybrids of the entities that make up GTN exist, the commonest being a combination of ETT and CC and CC and PSTT.[5,6]

Summary

Introduction

Gestational trophoblastic diseases (GTD) are characterized by abnormal proliferation of placental trophoblasts and include benign and malignant lesions.[1]The malignant lesions are often referred to as Gestational Trophoblastic Tumours/Neoplasms (GTN).Epithelioid trophoblastic tumor is a rare neoplasm and represents the most recent addition to the gestational trophoblastic tumor category.[2]. Gestational trophoblastic diseases (GTD) are characterized by abnormal proliferation of placental trophoblasts and include benign and malignant lesions.[1]. The malignant lesions are often referred to as Gestational Trophoblastic Tumours/Neoplasms (GTN). Epithelioid trophoblastic tumor is a rare neoplasm and represents the most recent addition to the gestational trophoblastic tumor category.[2] ETT was first characterized in 1998 as a rare form of trophoblastic disease composed of intermediate trophoblasts, cells with features that made it distinct from placental-site trophoblastic tumor (PSTT) and choriocarcinoma (CC).[3]. Since its characterization as an entity, only up to one hundred (100) cases have been reported in the literature worldwide with 2 in South Africa.[1, 2, 4] Hybrids of the entities that make up GTN exist, the commonest being a combination of ETT and CC and CC and PSTT.[5,6]

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Conclusion