Synchronous placental site trophoblastic tumor and choriocarcinoma

Abstract

Link of Video Abstract: https://youtu.be/bx7KdiTKiOQ   Introduction: Gestational trophoblastic neoplasia (GTN) comprises a series of malignancies characterized by abnormal proliferation of fetal trophoblastic tissue. GTN lesions refer to a class of malignant lesions that have distinct histopathologic features, including invasive hydatidiform moles, choriocarcinomas, placental site trophoblastic tumors (PSTT), and epithelioid trophoblastic tumor (ETT). Most often, they occur coexist separately, but there are also cases of mixed GTN with a combination of histologic PSTT, ETT, or choriocarcinoma. PSTT is a rare form of gestational trophoblastic disease (GTD). The percent incidence of this disease is 0.23% of total GTD and 1-2% of total GTN. The incidence rate of choriocarcinoma is also limited. Data collection on the incidence of mixed GTN has been more challenging due to the rarity of this disease. Case Description: We report a case of a 26-year-old female patient with choriocarcinoma and PSTT. The patient’s beta-human chorionic gonadotropin (β-hCG) levels remained elevated despite treatment with single-agent chemotherapeutic regimen. She underwent a series of chemotherapy treatments and two surgeries were required. The histological examination of the uterine tumor revealed a choriocarcinoma whilst the hysterectomy thereafter showed a PSTT. After the hysterectomy the β-hCG level continued to rise. Due to chemotherapy resistance, EMACO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) was changed to EP-EMA (Etoposide, cisplatin, etoposide, methotrexate, actinomycin-D). After two administrations of EP-EMA, β-hCG levels normalized. Conclusion:  This is a rare case of mixed GTN of choriocarcinoma and PSTT. Mixed GTN should be considered when chemotherapy is not effective in the treatment of GTN. These cases need to be reported to improve the diagnosis and management of patients.