Metastatic epithelioid trophoblastic tumor: a rare case report.

A 26-year-old parous woman presented with profuse vaginal bleeding. Obstetric history was P1L1A4, first pregnancy was terminated for molar pregnancy, second pregnancy was a term delivery by LSCS after 3 years, third and fourth pregnancies were unconfirmed abortions, fifth pregnancy was incomplete abortion at 8 week’s gestation, underwent D&E elsewhere, following which she had persistent vaginal bleeding. One week after evacuation, she was prescribed COC pills for 6 months to control bleeding. On examination, she was hemodynamically stable, profuse vaginal bleeding present, uterus enlarged to 12 weeks. Urine hCG was positive, and serum BhCG was 68,000 mIU/ml. Ultrasound pelvis showed enlarged uterus (11.1 9 9.7 9 9.1 cm) with a mixed echoic area in the endometrium measuring 7.4 9 6.3 cm suggestive of molar pregnancy (Fig. 1). Other abdominal organs were normal. With the diagnosis of GTD, suction evacuation and curettage were attempted, but no molar tissue was obtained. To relieve the complaint of heavy and persistent bleeding, TAH was done (ovaries retained). On further investigation, Chest X-ray showed cannon ball metastases (Fig. 2). CT scan brain showed metastases in right parietal cortex. Pathological examination showed uterus with cervix measuring 9 9 8 9 7 cm. On cut section, a nodular gray white growth of 6 9 6 cm seen in the endometrial cavity (Fig. 3). Cut section of cervix was unremarkable. Microscopic examination showed a tumor composed of monomorphic cells with round uniform nuclei and eosinophilic to clear cytoplasm with well-defined cell borders arranged in nests and cords (Figs. 4, 5). These cells are surrounded by eosinophilic material resembling keratin. Rich vascularity is observed with areas of necrosis. Invasion up to inner half of myometrium was seen. The diagnosis was ETT and pathologically FIGO stage IV disease. Prabha Devi K., Professor and HOD Bindhu Priya N., 3rd Year PG Resident Himabindu P., Associate Professor Department of OBGY, Siddhartha Medical College, Vijayawada 520008, Andhra Pradesh, India