Sentinel lymph node biopsy to exclude lymphatic spread in placental site trophoblastic tumour (original) (raw)
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Two cases of placental site trophoblastic tumor
Taiwanese Journal of Obstetrics & Gynecology, 2011
Placental site trophoblastic tumors (PSTTs) are an extremely rare form of gestational trophoblastic disease (GTD). Marchand and Ewing made the first observations in 1895 and 1910, respectively, and Kurman and Scully described the clinical and pathological characteristics of PSTTs in 1976, when the term trophoblastic pseudotumor was adopted to characterize the apparently benign nature of the disease [1,2]. Subsequent case reports have presented evidence of a sometimes aggressive, malignant, and fatal course of the disease, and the name was changed to PSTT in 1981 [3]. Histopathologically, PSTTs are characterized by a neoplastic monomorphic population of implantation-like intermediate trophoblastic cells, often as sheets of polyhedral, rounded, or occasionally spindle-shaped cells that infiltrate the myometrium extensively. Because of the rarity of this type of tumor, there is little information about its epidemiology and etiology, and few large series on diagnosis and treatment have been published . PSTTs are most often seen in patients of reproductive age and can follow a normal pregnancy, miscarriage, or GTD. Irregular vaginal bleeding is the most common presenting feature, although a wide range of other symptoms has also been reported, including galactorrhea, virilization, nephrotic syndrome, and polycythemia . We report two cases of PSTT treated successfully in our clinic.
Vojnosanitetski pregled
Introducton. Frequency of malignant gestational trophoblastic neoplasms (GTN) is estimated at 1.03 cases in 1,000 deliveries with 5 fold greater risk in patients younger than 20 and older than 40 years. Serum value of human chorionic gonadotropin is the most relevant parameter in diagnosis of GTN. In placental site trophoblastic tumor (PSTT), serum levels of chorionic gonadotropin do not have the same significance as they do in other malignant GTN. Definite diagnosis of PSTT is almost always confirmed by immunohistochemistry. Case report. In the course of just a few months (August 2016 to January 2017) in the Clinic for Obstetrics and Gynecology ?Narodni front? in Belgrade, two GTN patients were admitted and treated, with almost equal ultrasonography (pictures), operative findings and postoperative outcome. Due to histopathological and immunohistochemical examinations two different types of malignant GTN were confirmed. The first patient (admitted in August 2016), 26 years old, was ...
Management of placental site trophoblastic tumor
Medicine, 2018
Rationale: Placental site trophoblastic tumor (PSTT) is a very rare malignant tumor, belonging to a family of pregnancy-related illnesses, called gestational trophoblastic diseases (GTD). Less than 300 cases of PSTT have been reported in literature, with an incidence of ≈ 1/50,000-100,000 pregnancies representing only 0.23% to 3.00% of all GTDs. Patient concerns: Our report describes 2 additional cases of PSTT outlining their main diagnostic features and the subsequent management. The first case presented contemporary to a persistent hydatidiform mole in a 37-year-old woman, para 2042; whereas the second one originated 5 years after a miscarriage in 43-year-old woman, para 1031 with a previous diagnosis of breast cancer, and shared some features with placental site nodule (PSN), a benign condition. Diagnosis: The first case had a difficult diagnosis because there was an amenorrhea of 11th week with high serum beta-human chorionic gonadotropin (beta-HCG) and an initial ultrasound image of vesicular mole. After the Dilatation and Curettage, histology confirmed the previous hypothesis. However, the final histology of PSTT was obtained after major surgery. On the contrary, the diagnosis of the second case was less challenging but surprising, thanks to a routine trans-vaginal ultrasound showing a suspicious endometrial thickness positive for PSTT at a subsequent hysteroscopic guided biopsy. Interventions: The treatment consisted of hysterectomy and subsequent follow up. Lymphadenectomy or lymph node sampling were not performed due to the initial stage of the disease. Outcomes: In the first case, there were high values of serum beta-HCG that plummeted after the surgery, whereas in the second one they had been always negative. Hereafter, both went through a follow up with periodic serum oncological markers, imaging studies and clinical evaluation, which have showed negative result for 3 years and 15 months, respectively. Lessons: A detailed gynecological ultrasound examination could be extremely helpful to understand the next diagnostic step of echo-guided D&C or hysteroscopic biopsy and for a pre-operative staging assessment. On the contrary, determining the serum beta-HCG's curve is crucial just in case of an initial positive value to pursue clinical evaluation and follow-up. In case of good prognostic factors, the main therapy remains hysterectomy. Abbreviations: beta-HCG = beta-human chorionic gonadotropin, CC = choriocarcinoma, CK pool = cytokeratin pool, CT-scan = computed tomography scan, D&C = dilatation and curettage, EMA/CO = Etoposide, methotrexate with leucovorin rescue and actinomycin D, given on day 1 and 2 and cyclophosphamide and vincristine given on day 8, EP/EMA = Etoposide and platinum alternating with etoposide, methotrexate/folinic acid rescue, actinomycin-D, ETT = Epithelioid trophoblastic tumor, FIGO = International Federation of Gynecology and Obstetrics, GTD = gestational trophoblastic Disease, GTNs = gestational trophoblastic neoplasms, GTT = gestational trophoblastic tumor, HM = hydatidiform mole, HPL = human placental lactogen, PSN = placental site nodule, PSTT = placental site trophoblastic tumor, TE/TP = Paclitaxel, cisplatin/ paclitaxel, etoposide, WHO = World Health Organization.
PubMed, 2018
Choriocarcinoma and placental site trophoblastic tumor (PSTT) are rare varieties of gestational trophoblastic disease (GTD). PSTT alone constitutes about 1-2% of all trophoblastic tumors, which presents at early reproductive age and the serum beta-hCG level is much lower than choriocarcinoma. This tumor usually invades the myometrium and its depth of penetration is a prognostic factor. The first case report is regarding a 33-year-old woman with vaginal bleeding 3 months after abortion. The ultrasound exhibited heterogeneous and hypervascular mass related to previous cesarean scar. Serum beta-hCG level was 67 mIU/ml and chemotherapy was administered. However, due to severe vaginal bleeding and no regression in mass size, total abdominal hysterectomy was performed. Histopathological examination and IHC staining confirmed PSTT from previous cesarean section. The second case report is regarding a 33-year-old woman with cervicoisthmic choriocarcinoma, which was mistaken as cesarean scar pregnancy. The ultrasonography and elevated serum beta-hCG level suggested cesarean scar pregnancy. The patient was treated with methotrexate without any effect. Eventually, cervicoisthmic choriocarcinoma was detected after hysterectomy. A diagnostic error was made leading to possible uterus perforation along with incorrect chemotherapy that resulted in a life-threatening condition. It is concluded that PSTT and choriocarcinoma are the two important differential diagnoses of sustained elevated beta-hCG when imaging evidence is also suggestive. Although PSTT and cervicoisthmic choriocarcinoma are rare, they do exist and are on the rise.
Placental Site Trophoblastic Tumor: Case Report and Review of the Literature
MOH Journal of Medical Case Reports , 2024
Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, which includes both benign and malignant forms. Gestational trophoblastic neoplasia (GTN) includes both benign and malignant tumors of gestational trophoblasts. Placental site trophoblastic disease (PSTT) is a rare and potentially aggressive neoplasm originating from placental intermediate trophoblastic cells (ITC) at the implantation site. PSTT represents an abnormal proliferation of ITCs, which are involved in the embryo's implantation and the placenta's formation. ITCs are different from Cytotrophoblasts (CT) and syncytiotrophoblasts (ST). CTs are villous stem cells with high mitotic activity, while the STs, another villous cell, synthesize the human chorionic gonadotropin (hCG) and form the chorionic villi. The extravillous ITCs have features of the other two cells and are responsible for endometrial invasion and implantation. A 32-year-old female presented with symptoms indicative of a PSTT. Following a thorough diagnostic workup, including imaging and histopathological examination, the diagnosis of a localized PSTT was confirmed. Given the patient's desire for future fertility, a fertility-preserving approach was prioritized. She underwent a localized surgical procedure to excise the tumor while maintaining the integrity of her reproductive organs. Postoperative monitoring showed no evidence of residual disease or metastasis. This case highlights the feasibility and success of fertility-preserving surgery in the management of localized PSTT, emphasizing the importance of individualized treatment planning to balance oncologic control with fertility preservation.
Advanced Endometrial Cancer Detected at 7 Months after Childbirth
Gynecologic Oncology, 1997
a regular menstrual cycle. She had a normal spontaneous It is very rare to find endometrial cancers arising within a short vaginal delivery in October 1994 at the age of 30. The delivperiod following childbirth, presumably because pregnancy has a ery and the antenatal course were quite uneventful. She had protective effect against endometrial cancer mediated by elevated breast-fed her infant after delivery. Seven months after the secretion of progesterone. We present the case of a 30-year-old delivery, the patient presented with lower abdominal pain Japanese woman with stage IIIC endometrial cancer that was and vaginal bleeding for 4 weeks. Endometrial biopsies at found 7 months after childbirth. The patient was treated with a local gynecology hospital revealed endometrial cancer and surgery followed by 6 cycles of intravenous combination chemothe patient was referred to the Department of Obstetrics and therapy and oral administration of medroxyprogesterone acetate. Gynecology of Okayama University Medical School in May Histopathological examination of surgical specimen revealed 1995. poorly differentiated adenosquamous carcinoma of the endome-The patient was not obese and normotensive. There was trium with deep myometrial invasion, cervical stromal involvement, and pelvic and paraaortic lymph node metastases. The dis-no palpable lymphadenopathy. On pelvic examination, the ease progressed rapidly and the patient died of the disease. ᭧ 1997 uterus was 10 cm and firm. No abnormal indices were ob-Academic Press tained in the complete blood count and serological tests except for anemia. Values of serum estradiol and progesterone were 19.5 pg/ml (11-82) and 0.2 ng/ml (õ1.7), respectively.
Challenges in the management of placental site trophoblastic tumor
Journal of Basic and Clinical Reproductive Sciences, 2013
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 fl at vaginal ulcerative lesion diagnosed as PTSS 2 years after a term pregnancy. Beta human chorionic gonadotropin (-HCG) level was 110 mIU/mL and uterus was diff usely enlarged. Total abdominal hysterectomy was performed and on follow up, her serum -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 -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.
Journal of Ultrasound in Medicine, 2006
he differential diagnosis of highly vascular, intramural lesions of the myometrium includes arteriovenous malformation, gestational trophoblastic neoplasia, hemangiomata, sarcoma, and interstitial pregnancy. 1 We present an unusual case in which a patient with irregular uterine hemorrhage in the presence of increasing serum β-human chorionic gonadotropin (β-hCG) levels exhibited transvaginal sonographic and color Doppler imaging findings considered consistent with an interstitial pregnancy. After laparoscopy and curettage yielded normal findings but with the continuously rising serum β-hCG levels and the concern for gestational trophoblastic neoplasia, the patient underwent vaginal hysterectomy. Histopathologic findings confirmed choriocarcinoma.