Management of placental site trophoblastic tumor

Abstract

Rationale:Placental site trophoblastic tumor (PSTT) is a very rare malignant tumor, belonging to a family of pregnancy-related illnesses, called gestational trophoblastic diseases (GTD). Less than 300 cases of PSTT have been reported in literature, with an incidence of ≈ 1/50,000–100,000 pregnancies representing only 0.23% to 3.00% of all GTDs.Patient concerns:Our report describes 2 additional cases of PSTT outlining their main diagnostic features and the subsequent management. The first case presented contemporary to a persistent hydatidiform mole in a 37-year-old woman, para 2042; whereas the second one originated 5 years after a miscarriage in 43-year-old woman, para 1031 with a previous diagnosis of breast cancer, and shared some features with placental site nodule (PSN), a benign condition.Diagnosis:The first case had a difficult diagnosis because there was an amenorrhea of 11th week with high serum beta-human chorionic gonadotropin (beta-HCG) and an initial ultrasound image of vesicular mole. After the Dilatation and Curettage, histology confirmed the previous hypothesis. However, the final histology of PSTT was obtained after major surgery. On the contrary, the diagnosis of the second case was less challenging but surprising, thanks to a routine trans-vaginal ultrasound showing a suspicious endometrial thickness positive for PSTT at a subsequent hysteroscopic guided biopsy.Interventions:The treatment consisted of hysterectomy and subsequent follow up. Lymphadenectomy or lymph node sampling were not performed due to the initial stage of the disease.Outcomes:In the first case, there were high values of serum beta-HCG that plummeted after the surgery, whereas in the second one they had been always negative. Hereafter, both went through a follow up with periodic serum oncological markers, imaging studies and clinical evaluation, which have showed negative result for 3 years and 15 months, respectively.Lessons:A detailed gynecological ultrasound examination could be extremely helpful to understand the next diagnostic step of echo-guided D&C or hysteroscopic biopsy and for a pre-operative staging assessment. On the contrary, determining the serum beta-HCG's curve is crucial just in case of an initial positive value to pursue clinical evaluation and follow-up. In case of good prognostic factors, the main therapy remains hysterectomy.

A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors

“…Compared to other trophoblastic tumors, the human chorionic gonadotropin (hCG) serum level is slightly elevated in most PSTT patients. In rare cases, the serum level of hCG can reach even 100,000 IU/L (50), which may be a result of tumors mixing with choriocarcinoma tissues. Although the metastasis tendency of PSTT is lower than that of choriocarcinoma, it occurs occasionally.…”

Uterine rupture secondary to undiagnosed placental site trophoblastic tumor: case report

“…The tumor has low hCG levels and growth rates. 1,3 As a result, women are often oligosymptomatic, whereas women with hydatiform mole (HM) present elevated serum hCG and symptoms proportional to the increased hormonal dosage. 5 Symptomatology is usually poor.…”

“…1 Women may present increased uterine volume, theca-lutein cysts and hemoptysis; however, these findings have a higher sensitivity in identifying HM than PSTT. 3 Cough and headache may point to metastases, as tumor cells target lungs, the nervous central system, lymph nodes and genital structures. 4 Amenorrhea and an enlarged uterus were the only clinical features noted in this case.…”

“…Placental site trophoblastic tumor (PSTT) is a malignant and rare form of gestational trophoblastic disease (GTD). [1][2][3][4] PSTT represents 0,2-3% of all cases of GTD and is estimated to affect 1/50.000-100.000 pregnancies. 5 Only 725 cases of PSTT have been described in the literature.…”

Produksi Total Reactive Oxygen Species Pada Kultur Jaringan Mola Hydatidosa Komplit Dengan Pemaparan 17-Beta Estradiol

“…8 Penyakit keganasan trofoblas (Tumor Trophoblas Gestasional) dapat menimbulkan gejala klinik ringan sampai berat yang dapat mengakibatkan kematian. 9 Gejala klinik yang ditimbulkan tergantung dari daya invasif tumor dan kemampuan metastasisnya. Sehingga deteksi dini dan penanganan yang tepat diperlukan untuk pengobatan penyakit ini.…”