8665 Minimally Invasive Surgical Management of Placental Site Trophoblastic Tumor

Abstract

<h3>Study Objective</h3> We present a unique case of presumed stage 1 placental site trophoblastic tumor (PSTT) with an incidental pancreatic mass noted on MRI. A minimally invasive surgical approach was planned in combination between gynecologic oncology and surgical oncology. <h3>Design</h3> Single patient case report. <h3>Setting</h3> Academic quaternary care hospital. <h3>Patients or Participants</h3> A 31-year-old G4P0131 was diagnosed with PSTT four months following a spontaneous abortion. Her preoperative evaluation included a β-hCG which plateaued at 80 milliunits/mL, magnetic resonance imaging with a 2 cm mass in the body of the pancreas, and no other evidence of metastatic disease. The pancreatic mass had imaging characteristics suggestive of a pseudopapillary neoplasm of the pancreas. Patient declined preoperative upper endoscopic ultrasound with biopsy. Due to the presumed low malignant potential of the pancreatic lesion and low likelihood of metastatic disease to the pancreas, she was deemed low-risk with a WHO score of 3. She had completed childbearing and surgical management with hysterectomy was recommended. <h3>Interventions</h3> A combined robotic assisted total laparoscopic hysterectomy and laparoscopic distal pancreatectomy and splenectomy. <h3>Measurements and Main Results</h3> The patient was discharged home on postoperative day three after the above procedure and had an uncomplicated postoperative course. Final pathology revealed a metastatic implant in the pancreas. The patient has since completed adjuvant chemotherapy with EMA/CO. β-hCG down trended to within normal limits and the patient currently has no evidence of disease. <h3>Conclusion</h3> We present a case of a rare tumor with an unusual metastatic pattern. Given its rarity, minimally invasive surgical management should remain the standard for low risk PSTT. However, preoperative biopsy could be beneficial with unusual imaging findings as high risk PSTT requires chemotherapeutic management.