Sonographic appearance of gestational trophoblastic disease evolving into epithelioid trophoblastic tumor
Article first published online: 12 JAN 2010
Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound in Obstetrics & Gynecology
Volume 36, Issue 2, pages 249–251, August 2010
How to Cite
Okumura, M., Fushida, K., Rezende, W. W., Schultz, R. and ZUGAIB, M. (2010), Sonographic appearance of gestational trophoblastic disease evolving into epithelioid trophoblastic tumor. Ultrasound Obstet Gynecol, 36: 249–251. doi: 10.1002/uog.7560
- Issue published online: 28 JUL 2010
- Article first published online: 12 JAN 2010
- Manuscript Accepted: 12 OCT 2009
- epithelioid trophoblastic tumor;
- gestational trophoblastic disease;
Epithelioid trophoblastic tumor is a distinctive but rare trophoblastic tumor. It derives from intermediate trophoblastic cells of the chorion laeve and is usually associated with a previous gestational event. We report the case of a patient who had undergone dilatation and curettage for a missed miscarriage. Three months later gestational trophoblastic disease was suspected because of persistent vaginal bleeding and high levels of β-human chorionic gonadotropin (β-hCG). Transvaginal ultrasound revealed irregular echolucent lacunae within the myometrium, some of them filled with low-resistance, turbulent blood flow on Doppler examination, emphasizing the diagnosis of gestational trophoblastic disease. The patient was treated with 12 courses of multiagent chemotherapy. After a 2-year remission, a low rise in serum β-hCG was observed. Transvaginal ultrasound revealed a well-circumscribed echogenic lesion with a diameter of 1.8 cm in the uterine fundus, with no detectable blood flow on Doppler imaging. A diagnosis of tumor of intermediate trophoblastic cells was suspected and total hysterectomy was performed. On pathological examination, the histological and immunohistochemical features were characteristic of epithelioid trophoblastic tumor. Most reported cases of epithelioid trophoblastic tumor have solitary nodules with sharp margins, which is consistent with our ultrasound findings. Ultrasound may be helpful in differentiating epithelioid trophoblastic tumor from placental-site trophoblastic tumor, another tumor of intermediate trophoblastic cells, which shows infiltrative growth insinuating between muscle fibers. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.