A case of metastatic mixed trophoblastic tumor

The authors present a case report of a patient with metastatic mixed trophoblastic tumor (MTT) comprised of choriocarcinoma (CC) and epithelioid trophoblastic tumor (ETT) with pulmonary metastases at presentation. The patient underwent surgical management fol-lowed by high-dose methotrexate EMA-EP (etoposide, methotrexate, and actinomycin-D - etoposide and cisplatin). Though the patient initially responded well to the therapy regimen, she eventually developed brain metastases, which were morphologically consistent with ETT. The authors conclude that while chemotherapy is likely effective against the CC component, the ETT component of the tumor remains relatively chemoresistant and continued to progress throughout her therapy. This case illustrates the difficulty in treating MTTs and a need for further studies and general guidelines.

Metastatic mixed trophoblastic tumor (MTT); Choriocarcinoma (CC); Epithelioid trophoblastic tumor (ETT).

[1] Imamura Y., Tashiro H., Saito F., Takaishi K., Ohba T., Fukunaga M., Katabuchi H.: “Choriocarcinoma coexisting with epithelioid tro-phoblastic tumor of the uterine horn”. Gynecol. Oncol. Rep., 2015, 14, 31.

[2] Gari A.: “Placental site trophoblastic tumor and choriocarcinoma: an unusual presentation”. BMC Res. Notes, 2015, 8, 703.

[3] Luk W.Y., Friedlander M.: “A Fibroid or Cancer? A Rare Case of Mixed Choriocarcinoma and Epithelioid Trophoblastic Tumour”. Case Rep. Obstet. Gynecol., 2013, 2013, 49275.

[4] Ngan H.Y.S., Seckl M.J., Berkowitz R.S., Xian Y., Golfier F., Sekha-ran P.K., Lurain J.R.: “FIGO Cancer Report 2015: Update on the di-agnosis and management of gestational trophoblastic disease”. Int.

J. Gynecol. Obstet., 2015, 131, S123.

[5] Davis M.R., Howitt B.E., Quade B.J., Crum C.P., Horowitz N.S., Goldstein D.P., Berkowitz R.S.: “Epithelioid trophoblastic tumor: A single institution case series at the New England Trophoblastic Dis-ease Center”. Gynecol. Oncol., 2015, 137, 456.

[6] Newlands E.S., Mulholland P.J., Holden L., Seckl M.J., Rustin G.J.: “Etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EMA) chemotherapy for patients with high-risk gestational tro-phoblastic tumors refractory to EMA/cyclophosphamide and vin-cristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors”. J. Clin. Oncol., 2000, 18, 854.