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Gestational Trophoblastic Neoplasia
Surgery and Platinum/Etoposide-Based Chemotherapy for the Treatment of Epithelioid Trophoblastic Tumor
  1. Janelle Sobecki-Rausch, MD*,†,
  2. Abigail Winder, MD*,†,
  3. Kruti P. Maniar, MD*,‡,
  4. Anna V. Hoekstra, MD, MPH*,†,§,
  5. Emily Berry, MD*,†,
  6. Karen Novak, CNP*,† and
  7. John R. Lurain, MD*,†
  1. *Feinberg School of Medicine,
  2. †John I. Brewer Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
  3. ‡Division of Surgical Pathology, Department of Pathology, Northwestern University, Chicago, IL; Northwestern University, Chicago, IL; and
  4. §West Michigan Cancer Center, Western Michigan University School of Medicine, Kalamazoo, MI.
  1. Address correspondence and reprint requests to John R. Lurain, MD, Prentice Women's Hospital 250 E Superior St, Suite 05-2168, Chicago, IL 60611. E-mail: jlurain@nm.org.

Abstract

Objective Epithelioid trophoblastic tumor (ETT) is a rare variant of gestational trophoblastic neoplasia that develops from chorionic-type intermediate trophoblast, simulates carcinoma, presents years after a pregnancy event, is associated with low or normal human chorionic gonadotropin levels, and is relatively resistant to chemotherapy. Our aim was to identify the role of surgery in combination with platinum/etoposide-based chemotherapy in the management of both localized and metastatic ETT.

Methods A retrospective review was performed of women with ETT treated at a gestational trophoblastic disease center from 2010 to 2016.

Results Five patients were identified who had complete records. Mean age was 38.0 years. Three women presented with abnormal uterine bleeding, 2 women presented with respiratory complaints, and 1 woman was asymptomatic. Two women had no identifiable antecedent pregnancy, 2 women had spontaneous abortions, and 1 woman had a normal term delivery before diagnosis. Four (80%) of 5 women had metastatic pulmonary disease. All 5 women underwent hysterectomy, and 3 women had resection of metastatic pulmonary disease. The 4 women with metastatic disease were also treated with chemotherapy. All 5 women are currently without evidence of disease.

Conclusions Surgery, including hysterectomy and resection of metastatic disease, is an important component in the treatment of women with ETT. Adjuvant chemotherapy with a platinum/etoposide-containing regimen should be used in women with metastatic disease. All 5 women with ETT in this series were cured using this approach, including the 4 who had metastatic disease.

  • Epithelioid trophoblastic tumor
  • gestational trophoblastic neoplasia
  • surgery
  • chemotherapy

https://doi.org/10.1097/IGC.0000000000001278

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    Footnotes

    • The authors declare no conflicts of interest.

    • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.ijgc.net).