Fatal outcome in the patient with the suspected ectopic pregnancy and diagnosed epithelioid trophoblastic tumor

Aleksandar Z Dobrosavljevic; Branka Nikolic; Rastko Maglić; Ivana Petrović; Goran G Stanković

doi:10.2298/VSP170314177D

Aleksandar Z Dobrosavljevic Clinic of Obstetrics and Gynecology “Narodni front”, Belgrade, Serbia
Branka Nikolic Clinic of Obstetrics and Gynecology “Narodni front”, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Rastko Maglić Clinic of Obstetrics and Gynecology “Narodni front”, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Ivana Petrović Institute for Cardiovascular Disease “Dedinje“, Belgrade, Serbia
Goran G Stanković University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Clinical Center of Serbia, Institute for Cardiology, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP170314177D

Keywords: diagnosis, histological techniques, postoperative complications, pregnancy, ectopic, surgical procedures, operative, treatment outcome, trophoblastic neoplasms

Abstract

Abstract

Introduction. Epithelioid trophoblastic tumor (EТТ) is an extremely rare form and unusual type of trophoblastic tumor. In 1998 ЕТТ became an independent entity because it possesses specific histological and immunohistochemical features which make it different from placental site tumor and choriocarcinoma. ЕТТ origins from intermediate trophoblast and it can overlap with the squamous cell carcinoma as per differential diagnosis. The relevant literature data suggest that surgical treatment is a treatment of choice for ETT considering that its response to chemotherapy is considerably poor. Case report. A 35-years-old patient G3 P2 came to an examination due to the low pelvic pain and absence of menstrual cycle. She reported that menstrual cycles were irregular during the past year. During the bimanual pelvic examination, a painful tumefaction being approximately 8 cm was palpated in the pouch of Douglas. The patient was operated on as being suspected for ectopic pregnancy when it was noticed that the aforementioned tumefaction was located retroperitoneally immediately against rectosigmoid part of the colon. After the histopathological analysis of the sample, in order to make the final diagnosis, the immunohistochemical test was performed and it found that this EТТ. Due to an inadequate response to administered chemotherapy, both resection of rectosigmoid colon with appurtenant tumor and left hepatectomy with salpingectomy on both sides were performed considering a possibility of gestational trophoblastic neoplasia (GTN) after ectopic pregnancy. Because of dehiscence of colorectal anastomosis, relaparotomy with colostomy bag fitting was performed. The patient died on the day 40 after surgical treatment due to hepatic insufficiency. Conclusion. In order to make as much adequate treatment method of ETT as possible, it is necessary to organize a team work with multidisciplinary approach. Surgical resection of the tumor is a primary method for treating ETT.

Author Biographies

Branka Nikolic, Clinic of Obstetrics and Gynecology “Narodni front”, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia

Department of gynecology

Rastko Maglić, Clinic of Obstetrics and Gynecology “Narodni front”, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia

Department of gynecology

Ivana Petrović, Institute for Cardiovascular Disease “Dedinje“, Belgrade, Serbia

Department of cardiosurgery

Goran G Stanković, University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Clinical Center of Serbia, Institute for Cardiology, Belgrade, Serbia

Department for invasive diagnostics

References

REFERENCES

Shih IM, Kurman RJ. Epithelioid trophoblastic tumor: a neop-lasm distinct from choriocarcinoma and placental site tro-phoblastic tumor simulating carcinoma. Am J Surg Pathol 1998; 22(11): 1393–403.

Nikolić B, Ćurković A, Dikić SD, Mitrović A, Kuzmanović I, Arandjelović A, et al. Cervical poorly differentiated adenocarci-noma with dominant choriocarcinomatous pattern: A case re-port. Vojnosanit Pregl 2015; 72(7): 651–3.

Vencken PM, Ewing PC, Zweemer RP. Epithelioid trophoblastic tumour: A case report and review of the literature. J Clin Pa-thol 2006; 59(12): 1307–8.

Allison KH, Love JE, Garcia RL. Epithelioid trophoblastic tu-mor: Review of a rare neoplasm of the chorionic-type inter-mediate trophoblast. Arch Pathol Lab Med 2006; 130(12): 1875–7.

Meydanli MM, Kucukali T, Usubutun A, Ataoglu O, Kafkasli A. Epithelioid trophoblastic tumor of the endocervix: A case re-port. Gynecol Oncol 2002; 87(2): 219–24.

Fadare O, Parkash V, Carcangiu ML, Hui P. Epithelioid tro-phoblastic tumor: Clinicopathological features with an empha-sis on uterine cervical involvement. Mod Pathol 2006; 19(1): 75–82.

Okumura M, Fushida K, Rezende W, Schultz R, Zugaib M. Sono-graphic appearance of gestational trophoblastic disease evolv-ing into epithelioid trophoblastic tumor. Ultrasound Obstet Gynecol 2010; 36(2): 249–51.

Dobrosavljević A, Rakić S, Nikoli B, Raznatović SJ, Dikić SD, Milosević Z, et al. Diagnostic value of breast ultrasound in mammography BI-RADS 0 and clinically indeterminate or suspicious of malignancy breast lesions. Vojnosanit Pregl 2016; 73(3): 239–45.

Oldt RJ 3rd, Kurman RJ, Shih le M. Molecular genetic analysis of placental site trophoblastic tumors and epithelioid trophoblastic tumors confirms their trophoblastic origin. Am J Pathol 2002; 161(3): 1033–7.

Liu Q, Shi QL, Zhang JM, Li Y, Du YM, Shen SM, et al. Epithelioid trophoblastic tumor of the uterus: A case report of three cases. Chin Med J 2007; 120(8): 729–30.

Vemula S, Zeeshan S, Kasturi S, Madhavi P, Triveni B. Epithelioid trophoblastic tumor: A case report of a rare trophoblastic neoplasm. Int J Res Med Sci 2015; 3(3): 794–7.