Epithelioid Trophoblastic Tumor: Clinicopathologic and Immunohistochemical Analysis of Three Cases
A 32-year-old woman (gravid 3, para 1, artificial abortion 2) presented with a 3-month history of intermittent vaginal bleeding. Her previous pregnancy was 1 year prior, which was terminated by artificial abortion. Her hCG level was 313 mIU/mL. The patient underwent curettage and was diagnosed with choriocarcinoma. She was treated with several different chemotherapy regimens, due to persistent elevated serum hCG level. The main combination chemotherapy regimens included methotrexate (MTX)-leucovorin (1 cycle), actinomycin D (Act-D; 3 cycles), EMA/CO (etoposide+MTX+Act-D/cyclophosphamide and vincristine; 4 cycles), and EMA/EP (etoposide+MTX+Act-D/etoposide and cisplatin; 4 cycles), but her serum hCG level continued to be elevated to 945 mIU/mL. The patient underwent total abdominal hysterectomy with left-sided salpingoophorectomy, after which her serum hCG levels returned to normal (1.8 mIU/mL).\nThe uterus revealed a residual small hemorrhagic mass-like lesion measuring 0.8×0.4 cm (). On microscopic examination, the mass was revealed as a nodular lesion consisting of mononucleated epithelioid intermediate trophoblastic cells with hyalinization, which was reminiscent of keratinizing squamous cell carcinoma (). There was also a focal choriocarcinoma component (). Retrospective review of a previous curettage slide demonstrated several nests of relatively uniform intermediate trophoblastic cells.