Extrauterine lesions of intermediate trophoblast

Baergen RN, Rebecca N. Baergen, Joanne Rutgers, Rutgers J, Robert H. Young, Young RH
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2003 · vol. 22(4) , pp. 362–367 · doi:10.1097/01.pgp.0000092132.88121.d1 · PMID:14501817 · W2012728238
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This study describes seven new cases of extrauterine lesions of intermediate trophoblast, including placental site nodules and placental site trophoblastic tumors, and proposes they arise from ectopic pregnancies.

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This study describes seven new cases of extrauterine lesions of intermediate trophoblast, bringing the total reported instances to twelve. The lesions were located in the fallopian tube or paratubal region in six patients and in the ovary in one patient, ranging from 0.6 to 4 cm in diameter. Histological analysis identified four placental site nodules and three placental site trophoblastic tumors, with chronic salpingitis present in tubal cases and endometriosis observed in four instances. The authors propose that these lesions likely arise from prior ectopic pregnancies, noting that follow-up data for patients with PSTT was uneventful but insufficient to determine long-term behavior. Relevance to endometriosis: listed as a concurrent finding in four cases of extrauterine trophoblastic disease, though the paper's main focus is on rare trophoblastic pathology rather than adenomyosis or endometriosis itself.

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Abstract

Lesions of intermediate trophoblast arising in the uterus include exaggerated placental site, placental site nodule, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor. Only 12 examples of extrauterine lesions of intermediate trophoblast (ELIT) have been previously reported; 7 new cases are described herein. Six lesions were located in the fallopian tube or paratubal region and one in the ovary. The patients were 25 to 47 (average 36) years of age. The lesions ranged from 0.6 to 4 cm in diameter; four were cystic. The four placental site nodules (three tubal, one paratubal) were composed of small, sharply circumscribed nodules of intermediate trophoblast with no mitotic activity. The three PSTTs (two tubal, one ovarian) exhibited irregular stromal infiltration by intermediate trophoblast, mitotic activity, and necrosis. Chronic salpingitis was seen in the six tubal/paratubal cases, and endometriosis was seen in four cases. Immunoreactivity for human placental lactogen, human chorionic gonadotropin, and cytokeratin in two cases was consistent with an origin from intermediate trophoblast. ELITs presumably arise from previous ectopic pregnancies, a history of which was present in two of these patients. Follow-up, available on two of the three patients with PSTT, was uneventful at 6 and 12 years, but study of additional cases is necessary to reliably determine the behavior of extrauterine PSTTs.
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Extrauterine Lesions of Intermediate Trophoblast - Rebecca N. Baergen - Joanne Rutgers - Robert H. Young Summary: Lesions of intermediate trophoblast arising in the uterus include exaggerated placental site, placental site nodule, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor. Only 12 examples of extrauterine lesions of intermediate trophoblast (ELIT) have been previously reported; 7 new cases are described herein. Six lesions were located in the fallopian tube or paratubal region and one in the ovary. The patients were 25 to 47 (average 36) years of age. The lesions ranged from 0.6 to 4 cm in diameter; four were cystic. The four placental site nodules (three tubal, one paratubal) were composed of small, sharply circumscribed nodules of intermediate trophoblast with no mitotic activity. The three PSTTs (two tubal, one ovarian) exhibited irregular stromal infiltration by intermediate trophoblast, mitotic activity, and necrosis. Chronic salpingitis was seen in the six tubal/paratubal cases, and endometriosis was seen in four cases. Immunoreactivity for human placental lactogen, human chorionic gonadotropin, and cytokeratin in two cases was consistent with an origin from intermediate trophoblast. ELITs presumably arise from previous ectopic pregnancies, a history of which was present in two of these patients. Follow-up, available on two of the three patients with PSTT, was uneventful at 6 and 12 years, but study of additional cases is necessary to reliably determine the behavior of extrauterine PSTTs.

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Condition tags

endometriosis

MeSH descriptors

Fallopian Tube Neoplasms Ovarian Neoplasms Trophoblastic Tumor, Placental Site Trophoblasts Adult Adult Fallopian Tube Neoplasms Fallopian Tube Neoplasms Female Female Follow-Up Studies Follow-Up Studies Humans Humans Immunohistochemistry Immunohistochemistry Middle Aged Middle Aged Ovarian Neoplasms Ovarian Neoplasms

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