Case Of Placental Site Trophoblastic Tumor Research Articles

Pseudo-myometrial thinning in placental site trophoblastic tumors: a case series with multiparametric MRI.

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasm with few previous imaging case reports. We report multiparametric MRI findings in four cases of PSTT with special emphasis on the "pseudo-myometrial thinning" underlying the tumor. We reviewed multiparametric MRI and pathologic findings in four cases of PSTT from four institutions. Signal intensity, enhancement pattern, margins, and location of the tumors were evaluated, and myometrial thickness underlying the tumor and normal myometrial thickness contralateral to the tumor were measured on MRI. The myometrial thickness underlying the tumor was also measured in the resected specimen and compared with the myometrial thickness measured on MRI using the Friedman test. All tumors showed heterogeneous signal intensity on T1-weighted imaging, T2-weighted imaging (T2WI), and diffusion-weighted imaging. Three of the four tumors had a hypervascular area on dynamic contrast-enhanced (DCE) MRI. A hypointense rim on T2WI and DCE-MRI was seen in all tumors. All tumors protruded into the uterine cavity to varying degrees and extended into the myometrium close to the serosa. The myometrial thickness underlying the tumor measured on MRI (median thickness, 1.2mm) was significantly thinner than that measured on pathology (median thickness, 9.5mm) and normal myometrial thickness contralateral to the tumor on MRI (median thickness, 10.3mm) (P = 0.02), and there was no significant difference between the latter two. The thickness of the myometrium underlying the tumor on MRI was approximately one tenth of the thickness on pathology. Thus, the tumors appeared to have almost transmural invasion even when pathologically located within the superficial myometrium. This "pseudo-thinning" of the underlying myometrium and the hypointense rim on MRI could be caused by focal compression of the myometrium by the tumor, possibly due to the fragility of the myometrium at the placental site.

The frequency of hydatidiform mole in a tertiary care hospital from central India

Introduction: The gestational trophoblastic disease (GTD) is a group of pregnancy related tumours encompassing complete and partial mole, invasive moles, choriocarcinomas and placental site trophoblastic tumours. Amongst all GTD, hydatidiform moles are the most common form. Hydatidiform mole is a relatively common gynecological condition which could presents like spontaneous abortion, one of the most common gynecological emergencies. Materials and Methods: Present study is a retrospective analysis to determine incidence of hydatidiform mole for eight years duration.All women who were diagnosed of molar pregnancy by estimation of beta hCG and histopathological examination during1st Jan 2010 to 31st Dec 2017 were enrolled in this study. During the study period, there were 84 cases of Molar pregnancy out of 33856 total deliveries. Results: The total number of deliveries reported in the study period was 33856 out of which 84 cases were of gestational trophoblastic disease (GTD). The prevalence of GTD in this tertiary care hospital was 2.48 per 1000 deliveries. During the study period, we had received 55 samples of products of conception and 3079 hysterectomy specimens. Out of 3134 cases, 84 cases were diagnosed as GTD. Out of these 84 cases 81cases were hydatidiform mole. There were two cases of choriocarcinomas and one case of placental site trophoblastic tumour. Conclusion: The prevalence of hydatidiform mole was higher among all entities of gestational trophoblastic disease. The serum beta hCG levels are very sensitive and specific for diagnosis. Histopathological examination is helpful for confirming diagnosis. Keywords: Molar, Hydatidiform mole, Trophoblast.

A case of placental site trophoblastic tumor and a retrospective analysis

Placental site trophoblastic tumor (PSTT) refers to intermediates derived from intermediate trophoblasts, a particular type of trophoblastic tumor from the placenta site (gestational trophoblastic disease, GTD), whose pathological morphology and biological behaviors and other trophoblastic tumors are very different. Here, the authors report one case of PSTT, which is from the Anhui Provincial Hospital Affiliated to Anhui Medical University. A 39-year-old woman presented with abnormal uterine bleeding for four months after she had an abortion. She underwent curettage surgery in a local hospital, revealing a pathology of choriocarcinoma. Methotrexate (MTX) chemotherapy was ineffective, and blood hCG continued to rise, while in this hospital ultrasonographic examination the bottom of the uterus exhibited a uneven echo, with ill-defined and unclear intrauterine boundaries and a “honeycomb” structure in the serosa. After hysterectomy ,pathology revealed a bottom PSTT with invasion of the muscle which was greater than 50%. Microscopically, the tumor consists of sheets of intermediate trophoblastic cells invading the myometrium. Immunohistochemistry showed positive results for PCK, inhibin, hPL, and β-HCG (spotty +). A course of combined EMA-CO chemotherapy was performed ten days after the surgery, and the patient was then discharged after reviewing the normal indicators. The patient was followed for 36 months without recurrence.

A rare cause for gestational trophoblastic neoplasia: Placental site trophoblastic tumor

Placental site trophoblastic tumor is a rare sub-group of gestational trophoblastic neoplasia. There is a wide clinical spectrum of presentation and behaviour ranging from a benign condition to an aggressive disease with a fatal outcome. We report a case of placental site trophoblastic tumor in 23-year-old women with irregular vaginal bleeding during postpartum lactation period. In addition to persistent low level β-hCG titers, ultrasound examination revealed a suspicious low-echoic area in the myometrium consistent with gestational trophoblastic disease. After histopathological examination of the specimen achieved by ultrasound-guided dilatation and curettage of the uterus, the placental site trophoblastic tumor diagnosis was made and subsequently total abdominal hysterectomy was performed. The patient had an uneventful recovery, and no recurrence was detected for 40 months in the follow-up period.

Challenges in the management of placental site trophoblastic tumor

Placental site trophoblastic tumor (PSTT) is a rare neoplasm of intermediate trophoblastic cells of the placenta. Two cases of PSTT are presented. A 24‑year‑old G2P2 female presented with a flat vaginal ulcerative lesion diagnosed as PTSS 2 years after a term pregnancy. Beta human chorionic gonadotropin (β‑HCG) level was 110 mIU/mL and uterus was diffusely enlarged. Total abdominal hysterectomy was performed and on follow up, her serum β‑HCG level was undetectable. The second case is a 33‑year‑old female with a history of vaginal bleeding referred to hospital. She had myomectomy and the pathology was reported as leiomyosarcoma. We doubted the pathology result. By further pathological investigations and increase in β‑HCG consistent with PSTT, the diagnosis was made. The patient had hysterectomy. For both cases no adjuvant therapy was done and there has not been any sign of recurrence in them. It is thus concluded that complete resection in PSTT, could achieve long‑term remission.

Primary Cervical Placental Site Trophoblastic Tumor: A Rare Entity with an Unusual Presentation

Placental site trophoblastic tumour (PSTT) is the least common form of gestational trophoblastic neoplasia accounting for only 1-2% of trophoblastic tumors. Approximately 200 cases are reported in English literature. PSTT presenting as a cervical growth is even less common. Differentiation of PSTT from other types of GTN, non-neoplastic gestational trophoblastic disease and non-trophoblastic tumors is important clinically due to differences in their therapeutic approaches.Appreciation of the morphologic features and immunophenotype allows their accurate diagnosis.Although most of the cases of PSTT behave in a benign fashion,the clinical behavior of PSTT can sometimes be variable and several prognostic factors can help to predict the biological behavior of this condition. We report a rare case of placental site trophoblastic tumor, presenting as a cervical mass, in a 38 year old female, and review the literature.

Placental site trophoblastic tumor (PSTT) with multiple metastases and extremely poor prognosis

Placental site trophoblastic tumor (PSTT) is a rare type of gestational trophoblastic disease. There is a wide clinical spectrum of presentation and behavior ranging from a benign condition to an aggressive disease with a fatal outcome. PSTT limited to the uterus is in a good prognosis group, but PSTT with metastasis is a lethal disease. We document a case of PSTT with multiple metastases and extremely poor prognosis. A 36-year-old woman had abnormal irregular vaginal bleeding 14 months after her third pregnancy and delivery. The mitotic count of the tumor cells was quite high (23/10 high-power fields). It would have been difficult to remove the tumor by surgery because of the tumor size and its invasion, so we suggested chemotherapy. We treated her with EMA/CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) as a first-line regimen. During the sixth cycle of EMA/CO, the disease became drug-resistant and she died 8 months after the first symptom. This was a rare case among documented patients with PSTT with metastasis, with the patient having short-term survival (<1 year). We conclude that a high mitotic count and atypical undifferentiated pathological features are significant poor prognostic factors for survival in PSTT.

Placental Site Trophoblastic Tumor: A Study of 55 Cases and Review of the Literature Emphasizing Factors of Prognostic Significance

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease. Fewer than 200 cases have appeared in the English-language literature. Although 15% of reported patients have died of the disorder, it has proven difficult to predict the outcome in an individual case. The authors report 55 cases of PSTT in patients 20 to 62 years of age (average age, 32 years). Tumors were found an average of 34 months after the last known pregnancy. Five patients had a molar pregnancy a median of 23 months before PSTT was diagnosed. Initial serum or urinary levels of human chorionic gonadotropin (hCG) or β-hCG were elevated in more than three fourths of 47 patients evaluated. A large majority of patients (84%) had stage I disease. Stage II, III, and IV disease was present in 2%, 5%, and 9% of patients, respectively. Tumors averaged 5 cm in their greatest dimension. Located primarily in the endomyometrium, they consisted of infiltrating sheets of extravillous trophoblastic cells. Mitoses averaged 5 per 10 high-power fields. Nuclear atypia was grade 1 in 27% of tumors, grade 2 in 55%, and grade 3 in 18%. Areas of significant hemorrhage were apparent grossly in 35% of cases and necrosis in 31%. The tumors typically invaded deeply, 10% of them extending into the uterine serosa. All but 15% of patients had hysterectomy, with or without salpingooophorectomy. One third received chemotherapy but only 2 patients responded completely. During an average follow up of 4.6 years, 15% of patients died of metastatic tumor. Nine others were alive with metastases or recurrent disease. Metastases were most frequent in the lungs, liver, and vagina. Adverse prognostic factors included a high-stage tumor, a long pregnancy interval, a high mitotic rate, and high peak serum levels of hCG. On multivariate analysis, the only factors independently related to overall survival were stage and the presence of clear cytoplasm. Only stage and age independently predicted disease-free survival. In a review of 180 previously reported cases of PSTT, factors associated with survival included stage of disease, an interval of longer than 2 years from the preceding pregnancy, previous term pregnancy, and a high mitotic rate. Continued identification of significant prognostic factors should improve the follow up and management of patients having PSTT.

Placental site trophoblastic tumour: Clinical features and management

Objective. To describe the clinical features, treatment and outcome of all consecutive patients with placental site trophoblastic tumour (PSTT) treated at the Sheffield Trophoblast Centre and to compare these findings to other reports. Method. All cases of PSTT on the Sheffield Trophoblastic Tumour Centre database from 1984 to 2004 were reviewed. Data obtained included age at diagnosis, antecedent pregnancy (AP), interval from antecedent pregnancy until diagnosis, presenting features, presenting serum human chorionic gonadotrophin hormone (hCG) level, number and sites of metastases, treatment received, outcome and follow-up. Results. Seventeen patients with PSTT were identified from the database which incorporates a total of 7489 cases of trophoblastic disease. Fourteen (70.6%) were more than 30 years old at presentation; 5 were over 40. The median interval from pregnancy to diagnosis was 18 months (range 6 months to 22 years). The outcome of antecedent pregnancy was a female in 11 out of the 13 patients where the sex was known. Eleven (70.6%) of patients presented with irregular vaginal bleeding, with or without a preceding period of amenorrhoea. All 8 patients with non-metastatic (Stage I) disease were alive and well after hysterectomy (6), chemotherapy alone (1) or hysterectomy and chemotherapy (1) whereas only 4 of 9 patients with metastatic (Stage III/IV) disease were alive and well after treatment with chemotherapy and hysterectomy. Conclusion. PSTT is rare and accounts for 0.23% cases of gestational trophoblastic disease referred to this centre. It has a variety of presenting features and its course is unpredictable. Metastatic involvement and antecedent pregnancy interval greater than 4 years are poor prognostic factors. Hysterectomy is the primary mode of treatment in the majority of cases. However, chemotherapy can still play a major role when curative surgery is not feasible.

Placental site trophoblastic tumor presenting as subaponeurotic metastasis

Cases of metastatic placental site trophoblastic tumor (PSTT) have a very poor prognosis because these tumors tend to be less sensitive to chemotherapy than other types of gestational trophoblastic disease. We describe the case of a 25-year-old woman who presented with occipital tumor and abnormal vaginal bleeding. Hysterectomy, bilateral salpingo-oophorectomy, and occipital tumor removal revealed a primary PSTT in the uterus, with ovarian and occipital subaponeurotic metastases. She received etoposide, methotrexate, actinomycin-D/cyclophosphamide, vincristine chemotherapy and had a complete clinical remission. Fifteen months later, she had a recurrent subaponeurotic occipital tumor invading the cranium and underwent tumor removal along with cranial bone followed by local irradiation. She was then treated with etoposide, cis-platinum/etoposide, methotrexate, actinomycin-D chemotherapy and again had a remission for 5 months. The patient, however, had a left parietal subaponeurotic tumor, invading the dura mater, and received local irradiation. Soon after, she developed left orbital bone metastasis, treated by local irradiation. These bone metastases responded to the radiation completely. However, multiple organ metastases were found, and she died of the disease. This represents the first case of PSTT with initial subaponeurotic metastasis in a living patient. New modalities of treatment for high-risk or metastatic PSTT need to be developed.

Placental site trophoblastic tumor presenting as subaponeurotic metastasis

Cases of metastatic placental site trophoblastic tumor (PSTT) have a very poor prognosis because these tumors tend to be less sensitive to chemotherapy than other types of gestational trophoblastic disease. We describe the case of a 25-year-old woman who presented with occipital tumor and abnormal vaginal bleeding. Hysterectomy, bilateral salpingo-oophorectomy, and occipital tumor removal revealed a primary PSTT in the uterus, with ovarian and occipital subaponeurotic metastases. She received etoposide, methotrexate, actinomycin-D/cyclophosphamide, vincristine chemotherapy and had a complete clinical remission. Fifteen months later, she had a recurrent subaponeurotic occipital tumor invading the cranium and underwent tumor removal along with cranial bone followed by local irradiation. She was then treated with etoposide, cis-platinum/etoposide, methotrexate, actinomycin-D chemotherapy and again had a remission for 5 months. The patient, however, had a left parietal subaponeurotic tumor, invading the dura mater, and received local irradiation. Soon after, she developed left orbital bone metastasis, treated by local irradiation. These bone metastases responded to the radiation completely. However, multiple organ metastases were found, and she died of the disease. This represents the first case of PSTT with initial subaponeurotic metastasis in a living patient. New modalities of treatment for high-risk or metastatic PSTT need to be developed

Pathogenesis of Placental Site Trophoblastic Tumor May Require the Presence of a Paternally Derived X Chromosome

Placental site trophoblastic tumor (PSTT) is a neoplastic proliferation of intermediate trophoblasts that invades the myometrium at the placental site after a pregnancy. Less than 100 cases have been reported. Information of the sex assignment of the antecedent gestation is available in 21 cases: 18 of these were female. To explore this interesting phenomenon, we have determined the sex chromosome composition of the tumor tissue preserved in paraffin blocks for five new cases of this condition. The last documented gestational event included a normal vaginal delivery of female infants in three cases, normal vaginal delivery of an infant of unknown sex in one case and a molar gestation in one case. Using the X-linked human androgen receptor (AR) gene as a polymorphic marker, we showed that in all five cases the tumor had a likely XX chromosomal composition; and in four cases it was possible to determine that one of the X chromosomes was of paternal origin. In one case, the paternal X chromosome showed no polymorphism to either maternal X chromosomes. In addition, sensitive semi-nested PCR failed to show a human Y chromosome element in any of the five cases of PSTT. Overall, of 21 cases from the literature and 5 cases of ours, 89% (23 of 26) showed an XX genomic composition in PSTT, either by history or genetic analysis. These results suggest that most PSTT were derived from the antecedent female conceptus and were likely to have possessed a functional paternal X chromosome. Methylation status analysis at the AR locus was performed in the three PSTT in which the paternal X chromosome was identifiable. In two cases, the paternal AR locus was hypomethylated while the corresponding maternal locus was hypermethylated. The methylation status of other loci was not investigated. Collectively, sex chromosome analysis of five cases of PSTT with literature support suggests a unique genetic basis for the development of PSTT that involves the paternal X chromosome. Although largely speculative, an active paternal X chromosome may be of importance in the pathogenesis of PSTT.

Placental Site Trophoblastic Tumor drei Jahre nach der Menopause

This is a case report on a placental site trophoblastic tumour (PSTT) appearing three years after menopause. This rarest form of gestational trophoblastic disease is usually a disease of the reproductive years. To date, fewer than 100 cases of PSTT have been described. The clinical behaviour of PSTT is highly variable, although with a usually benign course, as was the case reported here with negative postoperative hCG and hPL serum radioimmunoassays, and no evidence of metastasis. In this case, therapy included only a simple hysterectomy. We postulate that our patient's age, which is more advanced than usual, has no bearing on the prognosis of her PSTT.

A case of a placental site trophoblastic tumor

A rare placental site trophoblastic tumor (PSTT) in a 39-year-old female was studied. This tumor, protruding into the uterine cavity, was histologically similar to tumors in previously reported cases of PSTT. Ultrastructurally, the characteristic finding was the presence of perinuclear filaments. Also, the tumor cells were strongly positive for hPL by immunohistochemical method. These findings suggest that this was a tumor caused by neoplastic proliferation of the extravillous intermediate trophoblast.

Placental site trophoblastic tumor presenting with scalp metastases

Placental site trophoblastic tumor (PSTT) usually presents with vaginal bleeding or amenorrhea and an enlarged uterus. Metastasis to the skin as the presenting sign, or as a metastatic site, has not been previously reported with PSTT. We report a case of PSTT in which the presenting sign was scalp metastases and the only other disease was a small focus in the uterus. The patient responded to multi-agent chemotherapy and repeated skin resection at the local site. She received 16 alternating cycles of etoposide-methotrexate-actinomycin D and cytoxan-oncovin (EMA/CO) and is currently without evidence of disease. Clinicians caring for reproductive age women should remain aware that gestational trophoblastic disease (GTD) may present in an unusual manner.

Erythrocytocis associated with a placental-site trophoblastic tumor

We present a case of placental-site trophoblastic tumor associated with erythrocytosis. This 42-year-old woman had persistent amenorrhea and low elevations of her hCG titer after term delivery of a healthy female infant. The woman was noted to have polycythemia of uncertain etiology and was treated with serial phlebotomy. Placental-site trophoblastic tumor was diagnosed and hysterectomy was performed, with subsequent resolution of the polycythemia. Although erythrocytosis has been reported with other gynecologic tumors, this is the first reported association with a placental-site trophoblastic tumor. A role has been suggested for placental lactogen in erythropoiesis during pregnancy based on previous animal studies. Diffuse positive staining for hPL is characteristic of placental-site trophoblastic tumors. We postulate that hPL may have played an ancillary role to erythropoietin in the erythrocytosis demonstrated in this case. Spider angiomata and splenomegaly are interesting clinical features previously described in association with placental-site trophoblastic tumors, and were demonstrated in this patient.

Ovarian conservation in placental site trophoblastic tumor

While isolated reports on the management and natural biology of placental site trophoblastic tumor (PSTT) continue to accumulate, little attention has been given to ovarian conservation in the surgical management of this disease. Review of the literature reveals ovarian involvement by this tumor to be infrequent and, when present, grossly apparent at laparotomy. In the reported cases, grossly normal ovaries did not contain pathologic evidence of tumor. This study reports two additional cases in which at least one ovary was preserved. Until more reliable criteria are available for predicting which cases of PSTT will pursue a malignant course, the option of ovarian conservation should be available to young patients requiring abdominal surgery, if the disease remains confined to the uterus.

Clinical characteristics of placental site trophoblastic tumor (PSTT)

Placental site trophoblastic tumor (PSTT) has been demonstrated to be a rare variant of gestational trophoblastic disease, with only 43 cases of this disorder having been reported in the English language literature since 1976. It is associated with a 20% mortality rate, occurs in young women, is very resistant to standard trophoblastic disease chemotherapy, and is generally treated by hysterectomy. This report describes an additional 5 cases of PSTT, two of whom died of their disease. It aims to clarify the varied clinical characteristics of the condition through a comparative analysis of these patients with those previously reported. Specific factors in the analysis include age, mitotic count, presence of marker hormones, preceding gestational situation, cause of death, survival time from diagnosis, tumor karyotype, and treatment. The study suggests that a preceding term pregnancy, a high mitotic ratio, and an older age group may be associated with a higher mortality rate. It also supports the premise that some patients, with a low mitotic ratio and other favorable histologic features, may be treated conservatively with curettage and very careful follow-up monitoring if they wish to preserve reproductive potential.