A Placental Site Trophoblastic Tumor Complicated with Arteriovenous Malformation: A Case Report

Abstract

A placental site trophoblastic tumor requires care in management and a prompt diagnosis. Placental site trophoblastic tumor is a rare type of gestational trophoblastic disease and displays non-specific presentations similar to those of uterine arteriovenous malformation and those of non-neoplastic gestational trophoblastic diseases such as placental polypoid tumor. Diagnosis from biopsy is extremely rare, and a delay in diagnosis can result in a poor prognosis for patients with placental site trophoblastic tumor. Although patients with placental site trophoblastic tumor, uterine arteriovenous malformation, and placental polypoid tumor are all commonly in their reproductive years, most patients with uterine arteriovenous malformation and placental polypoid tumor can have their fertility preserved with transcatheter arterial embolism treatment. However, hysterectomy is the primary choice of treatment, which should be promptly performed when placental site trophoblastic tumor is suspected. We report a patient presenting with a hypervascular uterine tumor with added complications of uterine arteriovenous malformation. Transcatheter arterial embolism was performed in attempt to manage arteriovenous malformation and to preserve fertility, but the treatment was incomplete and only temporary. This raised the suspicion of placental site trophoblastic tumor, which was confirmed by hysterectomy. Incomplete and temporary success with transcatheter arterial embolism may suggest placental site trophoblastic tumor.