Fig. 1Case 1. (A) A necrotic and slightly hemorrhagic tumor is evident in the lower uterine segment that extends to the upper cervix. (B) The tumor displays mononucleated intermediate trophoblastic cells. (C) The tumor cells surround, but do not invade the blood vessels.
Fig. 2Case 2. (A) The tumor remains as a small lesion after endometrial curettage. (B) Epithelioid trophoblastic tumor contains hyaline-like material and necrosis that resembled keratin, resulting in a resemblance to squamous cell carcinoma. (C) In addition, a small focus of choriocarcinoma component is identified.
Fig. 3Case 3. (A, B) The tumor appears as a bulky protruding mass. (C) The tumor cells are polygonal mononucleated cells with mild to moderately atypical nuclei and an abundant amount of clear or eosinophilic cytoplasm. Occasionally, syncytiotrophoblast-like bizarre cells are scattered among the epithelioid cells seen in typical epithelioid trophoblastic tumor.
Fig. 4Immunohistochemistry of the three cases. The tumor cells tend to be positive for cytokeratin 18 (A, case 1), E-cadherin (B, case 1), epidermal growth factor receptor (C, case 1), and p53 (D, case 2). (E) Serum human chorionic gonadotropin is focal positive (case 3). (F) MIB-1 labeling index of case 1 is 36.1%.
Table 1.Clinical features of three cases of epithelioid trophoblastic tumors
Case No. |
Age (yr) |
Symptom |
Recent gestation history |
Tumor size (cm) |
Serum hCG (mIU/mL) |
Treatment |
FIGO stage |
Follow-up (yr) |
Metastasis |
Outcome |
1 |
41 |
Vaginal bleeding |
FTD, unknown |
2.5 × 2.0, 15 mL (C) |
131.57 |
TAH |
I |
8 |
No |
CR |
2 |
32 |
Vaginal bleeding |
AA, 1 yr ago |
0.8 × 0.4, 25 mL (C) |
313.00 |
CTx, TAH |
I |
4 |
No |
CR |
3 |
42 |
Vaginal bleeding |
FTD, 15 yr ago |
3.8 × 3.3 |
138.90 |
TAH, CTx |
I |
No data |
No (initial) |
No data |
Table 2.Antibodies used in immunohistochemical study
Antibody |
Source |
Dilution |
Antigen retrieval |
Primary antibody incubation time |
CK18 |
Dako |
1 : 200 |
Mild (99°C, 30 min) |
24 min |
p63 |
Dako |
1 : 150 |
Mild (99°C, 30 min) |
16 min |
Inhibin |
Dako |
1 : 40 |
Standard (99°C, 60 min) |
52 min |
PLAP |
Zymed |
1 : 50 |
Standard (99°C, 60 min) |
1 hr 32 min |
hPL |
Dako |
Prediluted |
Standard (99°C, 60 min) |
1 hr |
hCG |
Biomedia |
Prediluted |
Standard (99°C, 60 min) |
24 min |
EGFR |
Ventana |
Prediluted |
Protease I (8 min) |
20 min |
E-cadherin |
Zymed |
1 : 100 |
Standard (99°C, 60 min) |
1 hr |
p53 |
Ventana |
Prediluted |
Mild (99°C, 30 min) |
20 min |
EMA |
Dako |
1 : 60 |
Standard (99°C, 60 min) |
1 hr |
MIB-1 |
Dako |
1 : 70 |
Standard (99°C, 60 min) |
1 hr 20 min |
Table 3.Immunohistochemistry results
Case No. |
CK18 |
p63 |
Inhibin |
PLAP |
hPL |
hCG |
EGFR |
E-cad |
p53 |
EMA |
MIB-1 LI (%) |
1 |
+ |
+, f |
- |
- |
- |
+ |
+ |
+ |
+ |
- |
36.1 |
2 |
+ |
+ |
+, f |
- |
- |
+, f |
+ |
+ |
+ |
- |
20.9 |
3 |
+ |
+, f |
- |
- |
- |
+ |
+ |
+ |
+ |
- |
24.7 |