Gustavo Yano Callado

Atypical placental site nodule detected via hysteroscopy – first case report from Brazil

Atypical placental site nodule (APSN) is a rare form of gestational trophoblastic disease (GTD) originating from the proliferation of intermediate trophoblasts, with uncertain clinical behavior. It is considered a potential precursor to rare forms of gestational trophoblastic neoplasia (GTN), such as placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). This report describes the first Brazilian case of APSN diagnosed via hysteroscopy in a 43-year-old woman following miscarriage. Histopathological analysis revealed a circumscribed, hyalinized aggregate of intermediate trophoblasts with nuclear atypia, positive immunostaining for PLAP and p63, and a Ki-67 index > 5%. The patient declined hysterectomy, opting for conservative management with close monitoring. After 12 months of follow-up, no progression was observed. This case emphasizes the diagnostic challenges of APSN, given its subtle presentation and overlap with benign placental site nodules or even PSTT/ETT. Hysteroscopy proved valuable for both diagnosis and fertility-preserving management. Although hysterectomy remains the definitive treatment in many cases, individualized approaches balancing oncologic safety and reproductive goals are increasingly considered. Long-term clinical vigilance is essential, as APSN may precede aggressive GTN forms. Multicenter studies and registries are urgently needed to establish evidence-based guidelines for the diagnosis, treatment, and follow-up of this rare lesion, improving patient outcomes in these uncommon forms of GTD. Key words: atypical placental site nodule – gestational trophoblastic disease – gestational trophoblastic neoplasia – placental site trophoblastic tumor – epithelioid trophoblastic tumor

HPV-independent vulvar squamous cell carcinoma: a case report and review of the literature

Vulvar cancer, a rare gynecological malignancy, accounts for 3-5% of cases and is most commonly squamous cell carcinoma. Prognosis is poorer in cancers unrelated to human papillomavirus (HPV), often associated with chronic inflammation. We report the case of a 42-year-old woman from São Paulo, Brazil, who presented with a vulvar lesion initially misdiagnosed as an ingrown hair. Despite treatment, the lesion progressed, and subsequent evaluation revealed invasive squamous cell carcinoma. Biopsy confirmed HPV-independent disease, with immunohistochemistry demonstrating aberrant p53 expression. Molecular analysis identified differentiated vulvar intraepithelial neoplasia, underscoring the distinct molecular pathways of HPV-related and HPV-independent carcinogenesis. This case emphasizes the importance of early diagnosis, comprehensive histopathological assessment, and further research to improve management and outcomes in HPV-independent vulvar cancer.