Insights into Uterine Epithelioid Trophoblastic Tumor: Characteristics, Diagnosis and Treatment Approaches

Rafael Ángel^*
*Correspondence: Rafael Ángel, Department of Otorhinolaryngology, Juntendo University School of Medicine, Tokyo, Japan, Email:

Introduction

Uterine Epithelioid Trophoblastic Tumor (ETT) is a rare form of gestational trophoblastic neoplasia, primarily affecting women of reproductive age. Characterized by its distinct histopathological features, including epithelioid trophoblastic cells, ETT presents diagnostic challenges due to its resemblance to other uterine tumors. Diagnosis typically involves histopathological examination supported by immunohistochemistry and molecular testing. Treatment strategies often comprise surgical intervention, chemotherapy and close surveillance due to the tumor's unpredictable behavior. Given its rarity, further research is essential to refine diagnostic criteria and optimize therapeutic approaches for improved patient outcomes. Uterine Epithelioid Trophoblastic Tumor (ETT) is a rare and aggressive form of Gestational Trophoblastic Neoplasm (GTN) arising from the placenta. While it represents only a small fraction of all trophoblastic tumors, its distinct histopathological features and clinical behavior warrant special attention. In this article, we delve into the characteristics, diagnostic methods and treatment approaches for uterine ETT, aiming to provide a comprehensive understanding of this condition.

Description

Uterine ETT typically occurs in women of reproductive age, with a median age at diagnosis around 30 years. Unlike other forms of GTN, such as choriocarcinoma or placental site trophoblastic tumor, ETT often presents as a solitary uterine mass. Histologically, ETT is characterized by the presence of epithelioid trophoblastic cells arranged in nests or sheets, resembling carcinoma. Immunohistochemical staining for trophoblastic markers, such as β-hCG (beta-human chorionic gonadotropin) and cytokeratin, aids in confirming the diagnosis [1]. The diagnosis of uterine ETT requires a multidisciplinary approach involving gynecologists, pathologists and radiologists. Clinical manifestations may include abnormal uterine bleeding, pelvic pain, or an enlarging uterine mass. Imaging studies, such as transvaginal ultrasound and magnetic resonance imaging (MRI), help evaluate the extent of disease and guide surgical planning. Histopathological examination of biopsy specimens obtained through hysteroscopy or dilation and curettage (D&C) is essential for definitive diagnosis [2].

Management of uterine ETT involves a combination of surgery, chemotherapy and occasionally radiation therapy. Surgical options range from conservative procedures, such as hysteroscopic resection or local excision, to more extensive surgeries, including hysterectomy with lymphadenectomy. The choice of surgical approach depends on factors such as tumor size, location and desire for fertility preservation. Adjuvant chemotherapy, typically using multi-agent regimens such as EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine), is recommended for high-risk or advanced-stage disease. Close monitoring of serum β-hCG levels is crucial for assessing treatment response and detecting disease recurrence [3]. Despite its aggressive nature, uterine ETT has a relatively favorable prognosis compared to other forms of GTN. The overall survival rate exceeds 80%, particularly for patients with localized disease and complete surgical resection. However, recurrence rates are higher in cases of incomplete initial surgery or resistance to chemotherapy. Long-term follow-up with serial imaging and β-hCG monitoring is essential to detect recurrence and ensure timely intervention.

Uterine Epithelioid Trophoblastic Tumor (ETT) is a rare type of gestational trophoblastic neoplasm, typically arising from the placenta. It's characterized by epithelioid trophoblastic cells, which are abnormal cells resembling those of the early placenta. ETT often presents with abnormal vaginal bleeding or an enlarged uterus [4]. Diagnosis of ETT involves a combination of imaging studies like ultrasound, MRI and histopathological examination of biopsy samples. Since it can mimic other uterine tumors, accurate diagnosis is crucial for appropriate management. Treatment approaches for ETT vary depending on the stage and extent of the tumor. Surgery, including hysterectomy or fertility-preserving procedures, is often the primary treatment for localized disease. Chemotherapy, particularly multi-agent regimens like EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide and vincristine), is employed for advanced or metastatic cases [5]. Due to the rarity of ETT, there's limited data on its optimal management. Multidisciplinary collaboration among gynecologic oncologists, pathologists and radiologists is essential for accurate diagnosis and tailored treatment plans. Further research is needed to better understand the biology of ETT and to develop more effective therapeutic strategies.

Conclusion

Uterine Epithelioid Trophoblastic Tumor poses diagnostic and therapeutic challenges due to its rarity and histological resemblance to other uterine malignancies. A multidisciplinary approach involving clinicians, pathologists and radiologists is crucial for accurate diagnosis and optimal management. Advances in imaging techniques and molecular markers hold promise for improving early detection and personalized treatment strategies for this rare gynecological malignancy.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

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