1.Exaggerated placental site gestational trophoblastic disease: A case report
Marie Mae Gonzales Pantolla‑Laxamana ; Merly R. Rosario‑Reamillo
Philippine Journal of Obstetrics and Gynecology 2023;47(3):149-162
Gestational trophoblastic diseases (GTDs) represent a unique group of lesions with an abnormal
proliferation of trophoblasts. GTD can be divided into molar lesions and nonmolar lesions. Partial
and complete hydatidiform moles and invasive moles are under molar lesions, whereas non‑molar
lesions include choriocarcinomas and lesions that are derived from intermediate trophoblasts (ITs).
These IT can be from the implantation site (exaggerated placental site [EPS] and placental site
trophoblastic tumor) or from the chorionic type (placental site nodule and epithelioid trophoblastic
tumor). EPS is a relatively uncommon form of GTD. It is a challenging condition for clinicians to
diagnose because of the limited number of reported cases. From 1990 to April 2022, there were
only 25 case reports published internationally, and this is the first local case report. Implantation site
ITs (ISITs) are difficult to distinguish histologically. Immunohistochemical staining such as Ki‑67 can
improve diagnostic accuracy by differentiating ISIT. Ki 67 will show staining of <1% in EPS. This is
the case of a 25‑year‑old patient, G6P5 (5005), who experienced vaginal bleeding associated with
pelvic and hypogastric pain after 13 weeks of missed menses. She was diagnosed with a molar
pregnancy and underwent an emergency total abdominal hysterectomy with bilateral salpingectomy
due to severe uterine bleeding. Histopathologic studies in this case showed diffuse and infiltrative
growth of atypical monomorphic ITs arranged in sheets and cords, infiltrating and separating
myometrial fibers. The uterine blood vessel wall was replaced with fibrinoid deposition, with areas of
hemorrhages and necrosis. There were also chorionic villi. The histopathological findings revealed
GTD arising from ITs, specifically EPS. This article describes the clinical presentation, diagnostic
procedure, and management, together with histopathological observations and a review of related
literature, of this rare GTD.
Gestational Trophoblastic Disease