Placental Site Trophoblastic Tumor and Related

Lesions of Intermediate Trophoblast

Placental site trophoblastic

tumor
– Rare
– A paternally derived X
chromosome and the absence
of a Y chromosome
– origin from the trophectoderm
of a female conceptum
Grossly as a myometrial mass that can be well
localized or ill defined. Solid hemorrhagic nodule is
seen distending the myometrium and protruding
into the endometrial cavity.
 Placental site
trophoblastic tumor

Microscopically:
– Large trophoblastic cells
– Abundant eosinophilic
– Cytoplasm and Nuclear
pleomorphism

The immunoreactivity for hPL is strong and

widespread, whereas that for hCG tends to
be focal
 Positivity for keratin, CD66a  no expression of p63, an useful
(CEACAM1), CD146 (Mel-CAM), feature in the differential
pregnancy-associated major diagnosis with epithelioid
basic protein, HLA-G, and trophoblastic tumor
inhibin.
Epithelioid
Trophoblastic Tumor
– originally described as a peculiar
change in the metastatic foci of
choriocarcinoma surgically
excised following chemotherapy
but is now known to also occur
de novo
– The primary tumor most
commonly occurs in the
endomyometrium but can
sometimes be centered in the
uterine cervix, develop outside
the uterus in places such as the
broad ligament, or even as a
primary lung tumor
Microscopically:
• Trophoblastic cells forming
nests and solid masses
Necrosis is extensive, and there
is a hyaline matrix with a
geographic configuration
Epithelioid Trophoblastic Tumor

Immunohistochemically, there is

– Diffuse reactivity: keratin, α-inhibin,

EMA, p63, HLA-G, and E-cadherin

– Focal reactivity: hPL, hCG, PLAP, and

CD116 (Mel-CAM).
 Tumorlike Conditions of Intermediate
Trophoblast
Exaggerated placental site
reaction
– Aka syncytial endometritis
– result of excessive but
otherwise normal
infiltration of the
implantation site by
intermediate trophoblast

 Trophoblastic cells infiltrating the myometrium

in a tumorlike fashion in exaggerated placental
site reaction
 Tumorlike Conditions of Intermediate
Trophoblast
Placental site nodules and
plaques
– single or multiple,
mostly well-
circumscribed, variably
cellular round or flat
lesions
– bundant amphophilic
– or acidophilic cytoplasm,
irregularly shaped
nuclei, and very scanty
– mitotic activity
 Other Tumors and Tumorlike
Conditions
Sarcomas
– Some of these
sarcomas have
developed following
radiation therapy for
cervical carcinoma or
other malignancies
– Some of the
angiosarcomas have
been of epithelioid
type, immunoreactive
for keratin, and
apparently arising
within leiomyomas
 Other Tumors and Tumorlike
Conditions
Malignant lymphomas
– can present initially in the endometrium
myometrium, or both
– Most tumors are of diffuse large B-cell type
 Other Tumors and Tumorlike
Conditions
Metastatic carcinoma
– from extrapelvic sites may
metastasize to the uterus
– The breast,
gastrointestinal tract,
kidney, and skin
(melanoma) are the most
frequent primary sites
– The myometrium is more
often involved than the
endometrium

Lobular breast carcinoma metastatic to

myometrium.