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A well-circumscribed border with peripheral Doppler signal in sonographic image distinguishes epithelioid trophoblastic tumor from other gestational trophoblastic neoplasms.

Qin J, Ying W, Cheng X, Wu X, Lu B, Liang Y, Wang X, Wan X, Xie X, Lu W - PLoS ONE (2014)

Bottom Line: The results showed that maximal diameter and hemodynamic parameters were not significantly different among ETT, PSTT and IM/CC (P>0.05).Thus, we draw the conclusions that the well-circumscribed border with peripheral Doppler signal may serve as a reliable sonographic feature to discriminate ETT from other types of GTNs.With further validation in a larger patient set in our ongoing multi-center study, this finding will be potentially developed into a non-invasive pre-operative GTN subtyping method for ETT.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China.

ABSTRACT
As epithelioid trophoblastic tumor (ETT) shares similar clinical features with other gestational trophoblastic neoplasms (GTNs), it is likely to be clinically misdiagnosed and subsequently treated in an improper way. This study aimed to identify the sonographic features of ETT that are distinct from other GTNs, including placental site trophoblastic tumor (PSTT) and invasive mole/choriocarcinoma (IM/CC). Here, we retrospectively analyzed ultrasound images of 12 patients with ETT in comparison with those of 21 patients with PSTT and 24 patients with IM/CC. The results showed that maximal diameter and hemodynamic parameters were not significantly different among ETT, PSTT and IM/CC (P>0.05). However, a well-circumscribed border with hypoechogenic halo was identified in the gray-scale sonogram in all 12 cases of ETT, while only in 1 out of 21 cases of PSTT and 1 out of 16 cases of IM/CC (P<0.001 for ETT vs. PSTT or IM/CC). Moreover, a peripheral pattern of Doppler signals was observed in 11 out of 12 ETT lesions, showing relatively more Doppler signal spots around the tumor border than within the boundary, while a non-peripheral pattern of Doppler signals in all 21 PSTT cases and 14 out of 16 IM/CC cases: with minimal, moderate or remarkable signal spots within the tumor, but not along the tumor (P<0.001 for ETT vs. PSTT or IM/CC). These distinct sonographic features of ETT correlated with histopathologic observations, such as expansive growth pattern and vascular morphology. Thus, we draw the conclusions that the well-circumscribed border with peripheral Doppler signal may serve as a reliable sonographic feature to discriminate ETT from other types of GTNs. With further validation in a larger patient set in our ongoing multi-center study, this finding will be potentially developed into a non-invasive pre-operative GTN subtyping method for ETT.

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Histological features of PSTT.(a) H&E staining profile showed an infiltrating growth pattern with the penetration of tumor cells into the myometrial smooth muscle and blood vessels (yellow arrows) at the tumor periphery. (b) Immunohistochemical staining showed diffusive cytoplasmic CD146. Both images with original magnification ×200.
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pone-0112618-g005: Histological features of PSTT.(a) H&E staining profile showed an infiltrating growth pattern with the penetration of tumor cells into the myometrial smooth muscle and blood vessels (yellow arrows) at the tumor periphery. (b) Immunohistochemical staining showed diffusive cytoplasmic CD146. Both images with original magnification ×200.

Mentions: The pathological features of ETT and PSTT have been well described previously [2], [19]–[21]. We here addressed several major morphological differences between ETT and PSTT. All ETT cases showed a nodular, expansile pattern with a well-circumscribed pushing border without invading the surrounding myometrial muscle fibers (Figure 4a and Figure S4), whereas the cells of PSTT always infiltrated and split normal myometrial muscle fibers (Figure 5a and Figure S5). ETT was composed of a relatively uniform population of mononucleated chorion leave-type intermediate trophoblastic cells. Necrosis, typically geographic necrosis, was usually presented, and became more extensive in the non-peripheral area rather than that at the periphery. In contrast, PSTT, characterized by the proliferation of implantation site intermediate trophoblasts, showed the minimal coagulative necrosis in the focal area. Moreover, we noted a different vascular morphology between ETT and PSTT: in ETT, small vessels were located in the viable tumor cell nests, surrounded by hyalinized and necrotic materials, and more vessels at the periphery of the tumor where necrosis was inconspicuous; whereas in PSTT, tumor cells invariably invaded, migrated through the vascular walls and even replaced the vascular endothelium. Immunohistochemical staining typically showed diffuse nuclear p63, negative cytoplasmic hPL and CD146 in ETT (Figure 4b and Figure S4), while p63(-), diffusive hPL(+), and strong CD146(+) in PSTT (Figure 5b and Figure S5). Histology of IM and CC had not been reviewed because no tissue was available, since these patients responded to chemotherapy.


A well-circumscribed border with peripheral Doppler signal in sonographic image distinguishes epithelioid trophoblastic tumor from other gestational trophoblastic neoplasms.

Qin J, Ying W, Cheng X, Wu X, Lu B, Liang Y, Wang X, Wan X, Xie X, Lu W - PLoS ONE (2014)

Histological features of PSTT.(a) H&E staining profile showed an infiltrating growth pattern with the penetration of tumor cells into the myometrial smooth muscle and blood vessels (yellow arrows) at the tumor periphery. (b) Immunohistochemical staining showed diffusive cytoplasmic CD146. Both images with original magnification ×200.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4232420&req=5

pone-0112618-g005: Histological features of PSTT.(a) H&E staining profile showed an infiltrating growth pattern with the penetration of tumor cells into the myometrial smooth muscle and blood vessels (yellow arrows) at the tumor periphery. (b) Immunohistochemical staining showed diffusive cytoplasmic CD146. Both images with original magnification ×200.
Mentions: The pathological features of ETT and PSTT have been well described previously [2], [19]–[21]. We here addressed several major morphological differences between ETT and PSTT. All ETT cases showed a nodular, expansile pattern with a well-circumscribed pushing border without invading the surrounding myometrial muscle fibers (Figure 4a and Figure S4), whereas the cells of PSTT always infiltrated and split normal myometrial muscle fibers (Figure 5a and Figure S5). ETT was composed of a relatively uniform population of mononucleated chorion leave-type intermediate trophoblastic cells. Necrosis, typically geographic necrosis, was usually presented, and became more extensive in the non-peripheral area rather than that at the periphery. In contrast, PSTT, characterized by the proliferation of implantation site intermediate trophoblasts, showed the minimal coagulative necrosis in the focal area. Moreover, we noted a different vascular morphology between ETT and PSTT: in ETT, small vessels were located in the viable tumor cell nests, surrounded by hyalinized and necrotic materials, and more vessels at the periphery of the tumor where necrosis was inconspicuous; whereas in PSTT, tumor cells invariably invaded, migrated through the vascular walls and even replaced the vascular endothelium. Immunohistochemical staining typically showed diffuse nuclear p63, negative cytoplasmic hPL and CD146 in ETT (Figure 4b and Figure S4), while p63(-), diffusive hPL(+), and strong CD146(+) in PSTT (Figure 5b and Figure S5). Histology of IM and CC had not been reviewed because no tissue was available, since these patients responded to chemotherapy.

Bottom Line: The results showed that maximal diameter and hemodynamic parameters were not significantly different among ETT, PSTT and IM/CC (P>0.05).Thus, we draw the conclusions that the well-circumscribed border with peripheral Doppler signal may serve as a reliable sonographic feature to discriminate ETT from other types of GTNs.With further validation in a larger patient set in our ongoing multi-center study, this finding will be potentially developed into a non-invasive pre-operative GTN subtyping method for ETT.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China.

ABSTRACT
As epithelioid trophoblastic tumor (ETT) shares similar clinical features with other gestational trophoblastic neoplasms (GTNs), it is likely to be clinically misdiagnosed and subsequently treated in an improper way. This study aimed to identify the sonographic features of ETT that are distinct from other GTNs, including placental site trophoblastic tumor (PSTT) and invasive mole/choriocarcinoma (IM/CC). Here, we retrospectively analyzed ultrasound images of 12 patients with ETT in comparison with those of 21 patients with PSTT and 24 patients with IM/CC. The results showed that maximal diameter and hemodynamic parameters were not significantly different among ETT, PSTT and IM/CC (P>0.05). However, a well-circumscribed border with hypoechogenic halo was identified in the gray-scale sonogram in all 12 cases of ETT, while only in 1 out of 21 cases of PSTT and 1 out of 16 cases of IM/CC (P<0.001 for ETT vs. PSTT or IM/CC). Moreover, a peripheral pattern of Doppler signals was observed in 11 out of 12 ETT lesions, showing relatively more Doppler signal spots around the tumor border than within the boundary, while a non-peripheral pattern of Doppler signals in all 21 PSTT cases and 14 out of 16 IM/CC cases: with minimal, moderate or remarkable signal spots within the tumor, but not along the tumor (P<0.001 for ETT vs. PSTT or IM/CC). These distinct sonographic features of ETT correlated with histopathologic observations, such as expansive growth pattern and vascular morphology. Thus, we draw the conclusions that the well-circumscribed border with peripheral Doppler signal may serve as a reliable sonographic feature to discriminate ETT from other types of GTNs. With further validation in a larger patient set in our ongoing multi-center study, this finding will be potentially developed into a non-invasive pre-operative GTN subtyping method for ETT.

Show MeSH
Related in: MedlinePlus