Indian Journal of Pathology and Microbiology
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Year : 2019  |  Volume : 62  |  Issue : 3  |  Page : 516-517
Catechism (Quiz 5)

Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India

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Date of Web Publication26-Jul-2019

How to cite this article:
Rekhi B. Catechism (Quiz 5). Indian J Pathol Microbiol 2019;62:516-7

How to cite this URL:
Rekhi B. Catechism (Quiz 5). Indian J Pathol Microbiol [serial online] 2019 [cited 2021 Jun 13];62:516-7. Available from: https://www.ijpmonline.org/text.asp?2019/62/3/516/263509

A 32-year-old lady with no comorbidities and without any significant family history underwent a cholecystectomy 4 years ago and subsequently presented with dyspepsia and abdominal heaviness of 1 month duration.

Her abdominal ultrasonogram revealed a left-sided adnexal lesion with mild peritoneal fluid and without any significant pelvic lymphadenopathy. Her serum celomic antigen (CA) 125 level was 125 U/mL.

She underwent a laparotomy and surgical debulking, including removal of the left ovarian tumor, with an intraoperative capsular rupture. The ovarian tumor was reported as a high-grade papillary serous adenocarcinoma, elsewhere. Two microscopic images of the tumor are provided [Figure 1] a, [Figure 1]b and [Figure 2]. Post-operative imaging revealed a well-defined cystic lesion in her right adnexa measuring 3.5 cm × 3.2 cm along with a hypodense mass in the periportal region and ? liver deposits.
Figure 1

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Figure 2

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  1. What is the diagnosis?
  2. What is the likely specific immunohistochemical antibody marker expressed in the form of granular cytoplasmic immunostaining in [Figure 2]?
  3. What other sensitive and relatively specific immunohistochemical stain(s) are expressed by this tumor?
  4. Which clinical history should be checked in such cases?

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   Answer of Catechism (Quiz 4) Top

An epithelioid trophoblastic tumor (ETT) is a rare form of gestational trophoblastic tumor, comprising neoplastic chorionic type intermediate trophoblastic cells.[1]

This tumor occurs in women with an average age of 36 years, with vaginal bleeding as the presenting symptom, followed by antecedent molar pregnancy in 36% cases and metastasis in 35%

cases.[2] Most cases show mild to moderate elevation of serum human chorionic gonadotrophin (HCG) levels, usually less than 2500 mIU/ml.[1]

Histopathologically, these tumors are nodular and invariably well-circumscribed, with focal infiltration at the periphery and are composed of relatively monomorphic trophoblastic cells arranged in the forms of cords and nests; with well-defined cell membranes and finely granular, eosinophilic to vacuolated cytoplasm. Tumor nuclei display up to moderate degree of atypia. Interspersed is eosinophilic, fibrillary, hyaline-like material, which can be confused with keratin and necrotic debris, as noted in this case.[3]

Differential diagnoses include placental site trophoblastic tumor (PSTT), choriocarcinoma, epithelioid leiomyomatous tumor and a keratinizing squamous cell carcinoma, likely of cervical origin. Nodular pattern, rather than extensively infiltrating, and monomorphic epithelioid cells, rather than pleomorphic; along with the striking eosinophilic material and necrosis are features in favor of a ETT, over a PSTT, which is composed of pleomorphic cells and displays vascular invasion. Immunohistochemical stains, such as co expression of p63 and focal positivity for human placental lactogen (HPL), as noted in the present case, are useful in confirming this diagnosis and in differentiating this from a squamous cell carcinoma, which lacks HPL immunostaining [Figure 2]. PSTT lacks p63 immunostaining and displays diffuse HPL immunostaining. Smooth muscle tumors(Leiomyomatous) express muscle markers, such as SMA, desmin and H-caldesmon, while a choriocarcinoma is characterized by pleomorphic cells, numerous mitotic figures and Ki67, exceeding 90% and high -HCG levels. [1,3]

   References Top

Hui P, Baergen P, Cheung ANY, Fukunaga M, Gersell D, Lage JM, Ronnett BM, Sebire NJ, Wells M. Gestational trophoblastic neoplasms. WHO classification of tumors of the uterine corpus. Epithelial tumors and precursors. In: Kurman RJ, Carcangui ML, Herrington S, Young RH.(Eds.), WHO Classification of Tumours of female reproductive organs, fourth ed., IARC, Lyon, 2014, p.161.   Back to cited text no. 1
Palmer JR. Advances in epidemiology of gestational trophoblastic disease. J Reprod Med 1994; 39: 155-62.   Back to cited text no. 2
Shih IM, Mazur MT Kuran RJ. In: Kurman RJ, Ellenson LH, Ronnett BM (EdS.). In: Blaustein's Pathology of the Female Genital Tract (6th Edition) New York, Springer 2011, p.1113-9.  Back to cited text no. 3

Correspondence Address:
Bharat Rekhi
Room Number 818, Department of Surgical Pathology, Tata Memorial Hospital, 8th Floor, Annex Building, Dr. E.B. Road, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.263509

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