Placental-site trophoblastic tumour: an unusual presentation with bilateral ovarian involvement

Abstract

A 33-year-old woman presented in August, 2000, with a 7-week history of amenorrhoea and a positive urine pregnancy test. She had had an early-pregnancy failure 3 years previously and a subsequent pregnancy 15 months later, which resulted in the delivery of a healthy baby girl by emergency caesarean section. Transvaginal ultrasonography showed no evidence of an intrauterine gestation sac and was otherwise unremarkable. At this time, measurement of serum human chorionic gonadotropin (hCG) was 104 IU/L. Subsequent transvaginal ultrasonography 1 month later showed a heterogeneous 21-mm mass adjacent to the right ovary and repeat hCG was 140 IU/L. She was given 50 mg/m methotrexate intramuscularly for a presumed failed ovarian ectopic pregnancy. However, subsequent serial serum hCG concentrations did not show the expected decline. A further dose of intramuscular methotrexate was therefore given in September, 2000; however, serum hCG continued to rise reaching a maximum of 214 IU/L in October, 2000. Repeat transvaginal ultrasonography at this time showed an abnormally vascular right ovary, which measured 50 29 34 mm. Laparoscopy showed a grossly abnormal right ovary and a right salpingo-oophorectomy was done. Histopathological examination showed an ovary infiltrated by a poorly circumscribed tumour that consisted of sheets and nests of mononuclear cells, with vacuolated or eosinophilic cytoplasm. Focal hyperchromatic nuclei and multinucleate cells were present. There were focal regions of necrosis and stromal hyalinisation (figure 1). On immunostaining, tumour cells were strongly positive for human placental lactogen with weak focal staining for hCG and placental alkaline phosphatase (figure 1). The features were strongly Lancet Oncol 2005; 6: 59–61