Gestational Trophoblastic Disease ECHO-Rare epithelioid trophoblastic tumor in an older patient with a long pregnancy latency

Rare epithelioid trophoblastic tumor in an older patient with a long pregnancy latency

Video Transcription

Video Summary

The session featured a case discussion of a 55-year-old woman with epithelioid trophoblastic tumor (ETT), a rare and often diagnostically challenging gestational trophoblastic neoplasm. Her tumor was discovered after a uterine mass was found on routine exam. Initial biopsy was difficult to interpret, but hysterectomy and staging surgery confirmed aggressive ETT with cervical/lower uterine segment origin, lymph node involvement, and residual metastatic disease. Genotyping confirmed the tumor was gestational in origin.<br /><br />Because she had extensive stage IV disease, she was treated with intensive platinum-based chemotherapy (EMA/EP), but experienced major toxicity, including severe G-CSF reaction, pancytopenia, and worsening neuropathy/renal issues. After chemotherapy became difficult to tolerate, she transitioned to pembrolizumab. Despite early concern for progression, later scans showed stability and then shrinkage of disease, and her hCG normalized. She is now clinically well.<br /><br />The discussion focused on key management questions: how long to continue pembrolizumab, whether surgery has a role for residual oligometastatic disease, the use of PET, ctDNA, and immune markers, and how to manage older patients who tolerate multi-agent chemotherapy poorly. Experts emphasized that ETT/PSTT are generally managed by FIGO stage rather than risk scores, often require expert pathology review, and may benefit from surgery when disease is limited.

Keywords

epithelioid trophoblastic tumor

gestational trophoblastic neoplasm

pembrolizumab

EMA/EP chemotherapy

FIGO staging

hCG normalization

oligometastatic disease

surgical management