11 May 2021: Articles
A Rare Case of Early Transformation of Gestational Trophoblastic Neoplasia Following Molar Pregnancy
Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease
Febia Erfiandi A* , Kemala Isnainiasih Mantilidewi B , Yudi Mulyana Hidayat B , Ali Budi Harsono C , Dodi Suardi B , Siti Salima C , Andi Kurniadi C , Indah P. Islami D , Hasrayati Agustina D , Birgitta Maria Dewayani D , Aisyah Shofiatun Nisa E , Huda Toriq EDOI: 10.12659/AJCR.930789
Am J Case Rep 2021; 22:e930789
Table 1. Diagnostic features of GTN [6].
| Diagnostic feature | Choriocarcinoma | PSTT | ETT |
|---|---|---|---|
| Age | Reproductive years (average 29 to 31 years) | 20 to 63 years (average 30 to 32 years) | 15 to 48 years (average 36 years) |
| Antecedent pregnancy | Term pregnancy, complete hydatidiform mole | Term pregnancy | Term pregnancy |
| Interval from index gestation | A few months to 14 months (average 2 months after term pregnancy and 13 months after complete mole) | 2 weeks to 17 years (median 12 to 18 months) | 1 to 25 years (average 6.2 years) |
| Clinical presentation | Vaginal bleeding, persistent GTD | Missed abortion, amenorrhea | Vaginal bleeding |
| Pretreatment hCG (mIU/mL) | >100×10 | ||
| Gross appearance | Circumscribed or invasive hemorrhagic masses | Expansive to infiltrative solid mass | Expansive solid mass |
| Tumor location | Corpus | Corpus | Cervix, lower uterine segment, corpus |
| Tumor border | Infiltrative | Infiltrative | Pushing |
| Tumor growth pattern | Trimorphic pattern consisting of all 3 types of trophoblast, extensive hemorrhage and necrosis | Large masses of tumor cells replacing vascular wall. Tumor cells split myometrial smooth muscle fibers at tumor periphery | Sheets, nests, and cords, geographic necrosis, deposition of hyaline-like material, colonizing mucosal surface epithelium |
| Tumor cells | Villous intermediate trophoblasts, syncytiotrophoblasts, and cytotrophoblasts | Implantation site-type intermediate trophoblast | Chronic-type intermediate trophoblast |
| Cytological atypia | Marked | Moderate to marked | Mild to moderate |
| Stroma | No intrinsic tumor stroma or vasculature, Ki-67 labeling index >90% | Intimately infiltrates myometrial muscle fibers | Presence of nearby decidualized stromal cells |
| Immunohistochemistry | Diffuse positivity for hCG, hPl, and HSD3B1 in syncytiotrophoblasts | Diffuse positivity for hPL and Mel-CAM, scattered multinuclear cells positive for hCG, Ki-67 labeling index 5% to 10% | Diffuse positivity for p63, rare individual cells positive for hPL and Mel-CAM, Ki-67 labeling index >10% |
| ETT – epithelioid trophoblast tumor; GTD – gestational trophoblastic disease; hCG – human chorionic gonadotropin; hPL – human placental lactogen; PSTT – placental site trophoblast tumor. | |||