Abstract
Placental site nodules (PSNs) and epithelioid trophoblastic tumors (ETTs) respectively represent non-neoplastic and neoplastic lesions of chorionic-type intermediate trophoblasts (ITs). Many patients with a PSN have a history of a cesarean section (CS) or therapeutic abortion. Recent evidence shows that a PSN may progress to an ETT. Herein, we describe a coexisting ETT and placental site trophoblastic tumor (PSTT) intimately associated with PSNs in the post-cesarean lower uterine segment of a 41-year-old woman. The patient presented with abnormal vaginal bleeding 1 year after a cesarean delivery for her most recent pregnancy. We speculated that the neoplasms had transformed from PSNs, the formation of which was related to faulty expulsion of the placental tissue or abnormal colonization of chorionic-type ITs during the CS. Neoplastic trophoblastic cells derived from PSNs displayed differentiation plasticity toward chorionic-type ITs and implantation site ITs that were respectively constituted of an ETT and PSTT.Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1597949195882123
Highlights
Gestational trophoblastic neoplasms are a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors (ETTs), and placental site trophoblastic tumors (PSTTs) [1]
The tumor represented a rare example of a coexisting ETT and PSTT that had likely transformed from Placental-site nodule (PSN)
The present case showed that PSNs had transformed into rare gestational trophoblastic neoplasms which were composed of ETTs and PSTTs
Summary
Gestational trophoblastic neoplasms are a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors (ETTs), and placental site trophoblastic tumors (PSTTs) [1]. Several microscopic hypocellular nodular lesions, closely associated with the mixed ETT and PSTT, were found in the endometrium of the lower uterine segment, the surface of the endocervix, and the fibrous scar of the CS (Figure 2B). They had circumscribed margins and were round or plaque-like in shape. Based on the histologic and immunohistochemical features, the smaller nodular lesions represented PSNs. In summary, the tumor represented a rare example of a coexisting ETT and PSTT that had likely transformed from PSNs. Microscopic findings of the endometrial curettage specimen were similar to those of the hysterectomy specimen, except that no PSNs were present in the former
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