Endometrial adenocarcinoma with trophoblastic differentiation

Objective. To report a case of stage IIIc poorly differentiated endometrial adenocarcinoma with trophoblastic differentiation and to review previously reported cases. Methods. The clinical course and histopathology of the case were reviewed, and a literature search for other reported cases was performed. Results. The tumor contained syncytiotrophoblast-like giant cells that stained positively for the beta subunit of human chorionic gonadotropin (β-hCG), and the patient's serum β-hCG level was elevated (95 mIU/ml), but became undetectable after treatment. β-hCG was used as a tumor marker during further therapy. At 16 months' survival, she remains without evidence of disease and with a β-hCG (level <5 mIU/ml). Nine other cases of trophoblastic differentiation in gynecologic nontrophoblastic tumors have been reported, five in endometrial carcinomas which we review. Conclusions. Trophoblastic differentiation in gynecologic nontrophoblastic tumors is rare. β-hCG may be useful as a tumor marker in these cases. The clinical behavior of these tumors has been aggressive, with advanced stages at diagnosis, early widespread metastases or recurrences and poor patient outcomes. The patient presented in this report, however, remains without evidence of disease 16 months following diagnosis and may be the longest survivor with this tumor reported to date.