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Weekly Chest CasesArchive of Old Cases

Case No : 1237 Date 2021-07-05

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  • Courtesy of Sung Hyun Yoon / Bundang Seoul National University Hospital
  • Age/Sex 37 / F
  • Chief ComplaintSPN in the RLL, serum hCG level elevation (about 20 mIU/ml). s/p Recent Op. for endometriosis. history of pregnancy and delivery (x2)
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Metastatic epithelioid trophoblastic tumor (ETT)
Radiologic Findings
Fig. 1. An irregular small nodule in the right lower lobe (RLL) of the lung.
Fig. 2. After 5 months, the small nodule in the RLL slightly increased in size. One year later after hormonal therapy, CT image shows decreased volume of the nodule. After discontinuation of hormonal therapy, the nodule slightly re-increased size.
Fig. 3. Positron emission tomography-CT scan showing no hypermetabolic lesion other than a nodule in the RLL.
Brief Review
Gestational trophoblastic neoplasms comprise a heterogeneous group of trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors (ETTs), and placental site trophoblastic tumors. ETTs are extremely rare. They originate from intermediate trophoblastic cells of the chorion laeve. The uterus is the primary site of ETTs (40%), followed by the cervix (31%). The lung is the most common extrauterine site, accounting for 19% of the cases. Very few ETTs show aggressive clinical behavior, and the sites of metastases include the lung, small bowel, fallopian tube, broad ligament, and endocervix. Although ETTs are most commonly associated with prior term deliveries (43%), they have also been associated with molar pregnancies (39%) and abortions (18%) occurring 2
References
1. Lewin SN, Aghajanian C, Moreira AL, Soslow RA. Extrauterine epithelioid trophoblastic tumors presenting as primary lung carcinomas: morphologic and immunohistochemical features to resolve a diagnostic dilemma. Am J Surg Pathol. 2009 Dec;33(12):1809-14.
2. Scott EM, Smith AL, Desouki MM, Olawaiye AB. Epithelioid trophoblastic tumor: a case report and review of the literature. Case Rep Obstet Gynecol. 2012;2012:862472.
3. Lei W, Zhang F, Zheng C, Zhao C, Tu S, Bao Y. Metastatic epithelioid trophoblastic tumor of the lung: A case report. Medicine (Baltimore). 2018 Apr;97(16):e0306.
4. Kavurmac
Keywords

No. of Applicants : 101

▶ Correct Answer : 2/101,  2.0%
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Govt. Kilpauk Medical College, Chennai , India VIGNESH K
▶ Correct Answer as Differential Diagnosis : 6/101,  5.9%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
▶ Semi-Correct Answer : 48/101,  47.5%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Korea University Guro Hospital , Korea (South) LEE SEOKYOUNG
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - , Korea (South) HYEYOUNG CHOI
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - , United Kingdom SAMSON KADE
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Seoul National University Bundang Hospital , Korea (South) SOWON JANG
  • - , Italy PAOLO BALDASSARI
  • - , Japan CHIAKI SATO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - , Japan KANAE TAKAHASHI
  • - , Korea (South) EUNJIN LEE
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - AIMS , India NITHYA HARIDAS MALIYAM
  • - CHU Lille , France PAUL LEBERT
  • - , Korea (South) YEJIN JEON
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Samsung Medical Center , Korea (South) SUHO KIM
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan KAZUMA TERAUCHI
  • - National Center for Global Health and Medicine , Japan TOMOKI IMOKAWA
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - algeria , Algeria ZAKARIA CHERAGA
  • - Jiangsu province hospital , China WANGJIAN ZHA
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