Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2023; 11(4): 938-944
Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.938
Epithelioid trophoblastic tumor of the lower uterine segment and cervical canal: A case report
Ling-Qin Yuan, Ting Hao, Guo-You Pan, Hui Guo, Da-Peng Li, Nai-Fu Liu
Ling-Qin Yuan, Guo-You Pan, Hui Guo, Da-Peng Li, Nai-Fu Liu, Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China
Ting Hao, Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China
Author contributions: Yuan LQ contributed to conceptualization; Pan GY and Guo H contributed to data curation and visualization; Yuan LQ, Hao T, Li DP, Liu NF contributed to formal analysis; Yuan LQ, Hao T contributed to writing-original draft preparation; Yuan LQ contributed to writing-review and editing; Yuan LQ contributed to manuscript revision; All authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ling-Qin Yuan, MD, PhD, Chief Physician, Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan 250117, Shandong Province, China. ylqsd@aliyun.com
Received: October 21, 2022
Peer-review started: October 21, 2022
First decision: November 16, 2022
Revised: November 29, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: February 6, 2023
Processing time: 107 Days and 20.7 Hours
Abstract
BACKGROUND

Epithelioid trophoblastic tumor (ETT) is the rarest type of gestational trophoblastic tumor (GTT). It has been reported that more than 50% of ETTs arise in the uterine cervix or the lower uterine segment. Here, we report a case of ETT within the lower uterine segment and cervical canal and discuss its manifestations, possible causes, and related influencing factors.

CASE SUMMARY

A 35-year-old woman (gravida 7, miscarriage 3, induction 2 with 1 being twins, para 2 of cesarean section, live 2), who had amenorrhea for 9 mo after breastfeeding for 22 mo after the last cesarean section, was diagnosed with ETT. The lesion was present in the lower uterine segment and endocervical canal with severe involvement of the anterior wall of the lower uterine segment and the front wall of the lower uterine segment where the cesarean incisions were made. Laboratory tests showed slight elevation of serum beta-human chorionic gonadotropin. Intraoperative exploration showed the presence of a normal-sized uterus body with an enlarged tumor in the lower uterine segment. The surface of the lower uterine segment was light blue, the entire lesion was approximately about 8 cm × 8 cm × 9 cm, with compression and displacement of the surrounding tissue. Histological examination diagnosed ETT. Immunohistochemical analysis showed positive expression of p63, with a Ki-67 proliferation index of 40%.

CONCLUSION

A search of the PubMed database using the search terms "cesarean section" and "epithelioid trophoblastic tumor" retrieved nine articles, including 13 cases of ETT and ETT-related lesions, all 13 cases had a history of cesarean section, and the lesions were all located at the cesarean section incision on the anterior wall of the lower uterine segment. The present case is the 14th reported case of ETT after cesarean section. Therefore, we deduced that cesarean section trauma had an important effect on the occurrence of ETT at this site.

Keywords: Epithelioid trophoblastic tumor; Lower uterine segment; Cervical canal; p63; Gestational trophoblastic tumor; Case report

Core Tip: Epithelioid trophoblastic tumor (ETT) is rare clinically. we describe a case of ETT in the lower uterine segment and cervical canal. The lesion was present in the lower uterine segment and endocervical canal where the cesarean incisions were made. A search of the PubMed database using the search terms "cesarean section" and "ETT" retrieved 13 cases of ETT, all of which had a history of cesarean section, and the lesions were located in the cesarean incision of the uterus. Therefore, we deduced that cesarean section trauma had an important effect on the occurrence of ETT at this site.