Epithelioid Trophoblastic Tumor Similar to Uterine Arteriovenous Malformation: A Case Report and Literature Review.

Epithelioid trophoblastic tumor (ETT) is a rare subtype of gestational trophoblastic neoplasia, most commonly arising in the cervix or lower uterine segment and often associated with mildly elevated serum human chorionic gonadotropin (hCG). Owing to its nonspecific clinical and imaging features, preoperative diagnosis remains challenging, particularly when the tumor exhibits hypervascular characteristics mimicking uterine arteriovenous malformation (AVM). We report the case of a 48-year-old perimenopausal woman who presented with sudden-onset massive vaginal bleeding following a short period of amenorrhea. Transvaginal color Doppler ultrasonography and contrast-enhanced computed tomography revealed a hypervascular cervical mass with multiple enlarged and tortuous vessels, raising strong suspicion of uterine AVM. Given the high risk of hemorrhage, preoperative uterine artery embolization was performed, followed by laparoscopic total hysterectomy with bilateral salpingo-oophorectomy. Histopathological and immunohistochemical examination confirmed the diagnosis of epithelioid trophoblastic tumor. Retrospective assessment revealed mildly elevated serum hCG levels. This case highlights the diagnostic challenge of epithelioid trophoblastic tumor presenting as a hypervascular cervical lesion mimicking uterine arteriovenous malformation. In perimenopausal women with acute vaginal bleeding and AVM-like imaging findings, ETT should be included in the differential diagnosis to avoid delayed recognition and to guide appropriate perioperative management.