Fertility preservation of PSTT by interventional therapy: a case report

Abstract

Introduction: Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease (GTD) and this disorder is usually seen in young women with a 20% mortality rate. Although hysterectomy is useful for treating PSTT, it is not the best choice for patients who wish to preserve their fertility. Due to the fact that PSTT is resistant to chemotherapy frequently, it is very important to find new therapeutic schedules used for PSTT. Case Report: The patient is a 24-year-old female, gravida 2, para 1, with intermittent vaginal bleeding episodes for ten days following her latest pregnancy of 50 days ago. Pelvic utrasonographic results showed a 4×5×5- cm mass in hypo-hyperechogenic areas of the uterine wall and the initial serum β-hCG level was 6,359 mIU/ml. Immunohistochemical analysis revealed that the Ki-67 proliferative index was about 10%; the tumor cells showed strong diffuse staining with Pan cytokeratin, human placental lactogen (hPL), placental alkaline phosphatase, and epidermal growth factor receptor (EGFR). Meanwhile, the tumor cells also showed focal positive with hCG. The histological and immunohistochemical findings led to the diagnosis of PSTT. At first, the patient took three courses of chemotherapy and three times of curettages, but the condition was not in remission. In order to preserve the patient's fertility, the patient underwent twice uterine artery drug pouring and embolism treatment. The drugs included adriamycin, cisplatin, and methotrexate. This therapy had gained a satisfactory effect. Conclusion: When the tumor is localized to uterus without diffuse infiltrative, for younger PSTT patients who wish to conserve fertility, the authors suggest that uterine artery drug pouring and embolism treatment could be considered.