Epithelioid Trophoblastic Tumor Presenting as an Adnexal Mass: Report of a Diagnostically Challenging Case.

Epithelioid trophoblastic tumor (ETT) is a rare neoplasm derived from chorionic intermediate trophoblast cells, representing less than 2% of all gestational trophoblastic neoplasms. Classically, ETT presents as a uterine mass in women of reproductive age following a term pregnancy. The time from pregnancy to tumor development varies from months to several years. ETT most often arises in the endometrium, followed by the cervix. Extrauterine ETT are extremely infrequent, with few cases reported in the literature. We report a case of a 41-year-old woman, with history of three term pregnancies who presented with abdominal pain and elevated beta human chorionic gonadotropin (ß-hCG) level, ten years after her last pregnancy. Imaging reported a 3.5 cm adnexal mass, suspicious for ectopic pregnancy. Hysterectomy and mass resection revealed a 4.7 cm, tan-yellow, necrotic mass adjacent to the broad ligament. Histologic evaluation in conjunction with immunohistochemical stains revealed a tumor consistent with ETT. No connection to the endometrium was found grossly or microscopically. DNA fingerprinting analysis revealed the tumor to have two copies of paternal alleles, as seen in molar gestations. One of the primary differential diagnoses for ETT is squamous cell carcinoma due to similar morphologic features. In challenging cases, genetic analysis demonstrating paternally derived genes can establish the diagnosis. In this report, we discuss the challenges in the diagnosis of extrauterine ETT, due to its rarity and highly variable presentation, given that appropriate diagnosis is critical for correct patient management.

Interesting Gross Case Workshop to Remedy Disconnect in Surgical Pathology Curriculum.

Introduction: This workshop was created by pathologists' assistants (PAs) who undertake specialized training programs heavily focused on grossing, which is the macroscopic inspection, evaluation, and sampling of pathology specimens for histologic evaluation by a surgical pathologist. Typically, pathologists or their trainees, during training, focus upon microscopic features, with less emphasis on the macroscopic appearance of disease. Methods: We developed monthly hour-long "interesting gross case workshops" (IGCWs) led by PAs to aid in the process of educating and refining pathology residents' grossing skills and abilities to diagnose at a macroscopic level. Our workshops include gross photography, grossing vocabulary, reference to standardized sampling manuals, and viewing of a specimen library to reinforce subject matter. This workshop was designed to train multilevel pathology providers including PA students, residents, fellows, and medical students, in addition to actively practicing PAs. This resource offers the audience preparation materials to host a workshop in any medical training facility. Results: Our use of the IGCWs has been evaluated positively over a 3-year period, with 78 of 150 participants stating they have increased confidence and capabilities to accurately assess and diagnose at the macroscopic level. Discussion: Utilizing this workshop can be valuable to teach the importance of a thorough gross description and tissue sampling for the diagnostic process. Future work includes expansion to additional pathology learners, improving photography database quantity and quality, and incorporating microscopic correlation when necessary.