EPITHELIOID TROPHOBLASTIC TUMOUR: A RARE CASE WITH AN UNUSUAL PRESENTATION

Here in we report a rare case of epithelioid trophoblastic tumour with a rare clinical presentation. Commonly, ETT presents with abnormal vaginal bleeding or lung metastases. Our case was a 22-year-old lady, Para 2, Live 2, Last Child Birth was one year with History of amenorrhoea presented with abdominal pain on and off, and initial Ultrasonogram had fluid in Pouch of Douglas with elevated beta HCG levels-421.4 miu/mL. She was diagnosed as ectopic pregnancy. Laparotomy was done, which turned out to be negative. So patient was referred to our institute with abdominal distension and ascites. MRI showed heterogeneously enhancing lesion in myometrium, lateral wall of cervix and anterior wall of vagina with gross ascites. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. Microscopy showed a neoplasm composed of round to polygonal intermediate trophoblastic cell arranged in sheets and clusters, the cells with high-grade nucleus and mitotic activity. Tumour cells were seen infiltrating the myometrium with extensive areas of necroses. Immunohistochemistry showed P63 strong positive, inhibin +ve, EMA +VE, PLAP +VE, beta HCG and Desmin were negative. Histology and IHC were consistent with Epithelioid trophoblastic tumour. This case shows that ETT can also present as abdominal pain with elevated beta HCG and mimic an ectopic pregnancy. The case is presented for its challenging diagnostic dilemma and rare presentation as abdominal distension and ascites.