Placental-site trophoblastic tumors: A case of resistant pulmonary metastasis

Background: A 52-year-old woman whose last known pregnancy was 12 years before presentation was diagnosed with mixed trophoblastic tumor that included placental-site trophoblastic tumor, epithelioid trophoblastic tumor, and focal choriocarcinoma. There was no clear evidence of metastatic disease on initial evaluation. Investigations: Histopathology, laboratory tests, immunohistochemistry, chest X-ray, CT scan of the chest, abdomen, and pelvis, fine-needle aspiration biopsy, PET-CT scan. Diagnosis: Metastatic chemoresistant placental-site trophoblastic tumor positive for EGFR, VEGF receptor, and platelet-derived growth factor receptor. Management: Abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic radiation, etoposide, methotrexate, actinomycin D/cyclophosphamide and vincristine chemotherapy, left thoracotomy with wedge resection, taxol, etoposide, cisplatin therapy, right thoracotomy with wedge resection.