Epithelioid Trophoblastic Tumor: Clinicopathologic and Immunohistochemical Analysis of Three Cases
A 41-year-old woman (gravid 2, para 2) was referred to the gynecology clinic due to vaginal bleeding. Her previous pregnancy was at term and uncomplicated. Ultrasonography demonstrated old placental remnants and dystrophic calcification. Levels of human chorionic gonadotropin (hCG) were slightly elevated (131.57 mIU/mL). The patient underwent curettage initially. Four days after the curettage, the patient visited the emergency room due to persistent abdominal pain. Uterine perforation was suspected, and total abdominal hysterectomy was performed. After the hysterectomy, her serum hCG level return to normal (1 mIU/mL).\nGrossly, the tissue volume obtained by curettage was 15 mL and a remnant mass in the size of 2.5×2.0 cm was identified in the lower uterine segment of the hysterectomy specimen. The tumor was focally hemorrhagic and fragile due to necrosis (). Microscopically, the tumor displayed nodular expansile growth of atypical mononucleated epithelioid trophoblastic cells lacking a dimorphic pattern (). Larger cells with bizarre nuclei were occasionally observed. Necrosis and frequent mitotic activities were identified. The tumor cells surrounded the blood vessels, but did not invade the vascular lumen ().