case_images: PMC6766115_01
case_images: Macroscopical and microscopical features of her second time abdominal wall mass resection. (a and b) Abdominal lesions, macroscopically, the surface of the tumor was white-tending to brown, with varying amounts of hemorrhage and necrosis. Microscopically, the lesion displayed infiltrative hyperplasia in the abdominal adipose fibrous tissue (c and d, H&E, x10). IHC showed moderate staining for CK (e x40), MEL-CAM (f x40), and HPL (h x40), focally positive for HCG (g x40). The Ki-67 proliferative index was about 20% (i x40).
case_images: CRIOG2019-5093938.001.jpg
case_images: PMC6766115_01_CRIOG2019-5093938.001.jpg
case_images: fig1
case_images: Macroscopically, the surface of the tumor was white-tending to brown, with varying amounts of hemorrhage and necrosis (Figures 1(a) and 1(b)). Microscopically, the lesion displayed infiltrative hyperplasia in the abdominal adipose fibrous tissue (Figures 1(c) and 1(d)). IHC showed moderate staining for CK (Figure 1(e)), MEL-CAM (Figure 1(f)), and HPL (Figure 1(h)), focally positive for HCG (Figure 1(g)). The Ki-67 proliferative index was about 20% (Figure 1(i)).
case_images: Abdominal hysterectomy, bilateral salpingectomy, left-sided ovarian cystectomy, the third time abdominal wall tumor resection and right-sided inguinal lymph node biopsy. (a, b, e, and f) The third time abdominal wall mass resectionthe tumor formed discrete nodules invading surrounding structures. (c and g) Abdominal hysterectomy specimens and bilateral salpingectomy. (h) Right-sided inguinal lymph node. (d) The repairing of abdominal wall defect.
case_images: CRIOG2019-5093938.002.jpg
case_images: PMC6766115_01_CRIOG2019-5093938.002.jpg
case_images: fig2
case_images: Due to re-recurrence of the tumor, the following decisions have been made: total abdominal hysterectomy, bilateral salpingectomy, the third time abdominal mass resection (We cut apart skin and subcutaneous fat 3-4 cm away from the original abdominal transverse incision), right-sided inguinal lymph node biopsy and repair of abdominal wall defect (Figure 2).
case_images: Histological feature of the third time abdominal wall tumor resection. Histologically, the tumor infiltrated adipose and fibrous tissue, and was surrounded by necrosis in the abdominal wall (a and b, H&E;x10). Scant syncytiotrophoblasts were immunoreactive to sall-4 (i x40). The tumor cells were positive for E-Ca (c x40), EGFR(d x40). Moreover, EMA (e x40) and HCG (f x40) were both positive, and the cells were negative to HPL (g x40) and PLAP (h x40).
case_images: CRIOG2019-5093938.003.jpg
case_images: PMC6766115_01_CRIOG2019-5093938.003.jpg
case_images: fig3
case_images: Microscopically, the tumor infiltrated adipose and fibrous tissue and was surrounded by necrosis in the abdominal wall (Figure 3). Moreover, EMA and HCG were both positive, but the cells were negative to HPL and placental alkaline phosphatase (PLAP) (Figure 3).
case_images: Features of epithelioid trophoblastic tumor and choriocarcinoma in the third time abdominal wall tumor resection. Most of the tumor tissue (ETT) (a x40; b x100) was characterized by nodular growth of medium-sized rumor cells arranged in nests or cords to large masses. The cells were relatively uniform. Nuclear atypia was generally moderate. Extensive necrosis appeared often. Small part of tumor tissue (CC) displayed a dimorphic population of trophoblast cells (syncytiotroblastic cells and cytotrophoblastic or intermediate trophoblastic cells) with marked hemorrhage and necrosis(e x40; f x100). Immunohistochemically, tumor cells were strongly positive for p63 (c x40) and negative for inhibin-alpha (d x40) in ETT, while they reacted positively to inhibin-alpha (h x40 ) but negatively to p63 (g x40) in CC.
case_images: CRIOG2019-5093938.004.jpg
case_images: PMC6766115_01_CRIOG2019-5093938.004.jpg
case_images: fig4
case_images: Small part of tumor tissue (CC) displayed a dimorphic population of trophoblast cells (syncytiotroblastic cells and cytotrophoblastic or intermediate trophoblastic cells) with marked hemorrhage and necrosis (Figure 4). CC (Figure 4). Combining with the patient's clinical presentation a final diagnosis of mixed GTN located in the cesarean scar was made (ETT 90% and CC 10%).