A metastatic unclassified trophoblastic tumour with spontaneous bilateral pneumothoraces
Keywords: Epithelioid Trophoblastic tumour, Pneumothoraces, Gestational trophoblastic disease
AbstractGestational trophoblastic disease (GTD) is a spectrum of diseases associated with pregnancy. Epithelioid trophoblastic tumour (ETT) is a rare neoplastic proliferation of the intermediate trophoblast that can be distinguished from choriocarcinoma. A 35-year-old female presented with persistent vaginal bleeding, raised beta human chorionic gondaotrophin (β-HCG) (13 175 IU/l) and, on ultrasound, what appeared to be a molar pregnancy. Microscopy and immunohistochemistry confirmed the diagnosis of ETT. Computed tomography (CT) scan confirmed bilateral small lung and liver metastases, and vaginal sonar, a single metastasis next to the urethra. Combination etoposide and cisplatin chemotherapy was completed. Restaging lung CT detected numerous cystic lesions and bilateral spontaneous pneumothoraces, caused by the rupture of subpleural cystic lesions. After second-line methotrexate-based chemotherapy, the patient was admitted to hospital with shortness of breath. Bilateral underwater drains were inserted to address the complication of persistent spontaneous bilateral pneumothoraces, but she passed away. ETT is a rare malignant disorder associated with pregnancy. No standard treatment guidelines exist, and these patients need the efforts of a multidisciplinary team with experience in oncology.
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