Placental site trophoblastic tumor unprecedented by conception: a very rare presentation

Placental site trophoblastic tumour is the rare variant of gestational trophoblastic neoplasia with incidence rate of approximately 1/100,000 of all pregnancies. Histologically it is characterized by intermediate trophoblastic cells with few syntical elements. The index report depict a 20 years old unmarried female with no history of conception presenting with abnormal uterine bleeding and mildly elevated serum β-HCG level. Multi-modality treatment was given and she had fair outcome.

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A rare case of placental site trophoblastic tumor

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213491 ◽

2021 ◽

Vol 10 (9) ◽

pp. 3594

Author(s):

Shilpa Bajpai ◽

Prasad Lele

Keyword(s):

Vascular Tissue ◽

Critical Role ◽

Placental Site Trophoblastic Tumor ◽

Presenting Symptoms ◽

Trophoblastic Tumor ◽

Trophoblastic Cells ◽

Dilation And Curettage ◽

Nephritic Syndrome ◽

Placental Site ◽

Β Hcg

Placental site trophoblastic tumor (PSTT) is a very rare tumor of young women and unique form of gestational trophoblastic disease (GTD) representing a neoplastic transformation of intermediate trophoblastic cells that play a critical role in implantation. It accounts for 1-2% of all GTNs, incidence of it being 1 in 1,00,000 pregnancies. It displays a wide clinical spectrum from benign lesion within uterus to highly metastatic features with widespread features of metastasis and can be difficult to control even with surgery and chemotherapy. Unlike other forms of GTD, it is characterized by low β-hCG levels because it is a neoplastic proliferation of intermediate trophoblastic cells. PSTT can develop following all kind of pregnancies, whereas approximately 50% of PSTT cases occur after a normal pregnancy and other cases follow abortion, term delivery, ectopic pregnancy and molar pregnancy. Histopathologically, PSTT has proliferation of intermediate trophoblastic cells and absence of villi. It shows less invasion of vascular tissue and using immune histochemistry revealed that PSTT cells expressed HPL more than β-hCG, characterized by increased expression of the HPL in histological section as well as serum. The most common presenting symptoms of PSTT are irregular vaginal bleeding associated with uterine sub involution. Patient can also be presented with amenorrhea, nephritic syndrome, abdominal pain, galactorrhea and hemoptysis. Hence any case of unusual bleeding should be investigated with dilation and curettage and βHCG levels. Although the majority of patients of the non-metastatic PSTT are cured by hysterectomy but in metastatic cases, it requires aggressive treatment with chemotherapy and radiation. Due to its seldom occurrence and uncharacteristic clinical presentation, to reach a correct diagnosis and management is a surgeon’s nightmare and can be very challenging.

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“It’s not lupus”. A placental site trophoblastic tumor presenting as a lupus-like paraneoplastic syndrome. A grand round case

Lupus ◽

10.1177/0961203320981765 ◽

2021 ◽

pp. 096120332098176

Author(s):

Sarah J van der Lely ◽

Jeffrey Boorsma ◽

Marc Hilhorst ◽

Jesper Kers ◽

Joris Roelofs ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Lupus Erythematosus ◽

Kidney Biopsy ◽

Gestational Trophoblastic Disease ◽

Grand Round ◽

Placental Site Trophoblastic Tumor ◽

Trophoblastic Tumor ◽

Anchoring Bias ◽

Placental Site ◽

History Of

Introduction: Placental site trophoblastic tumor (PSTT) is a rare subtype of gestational trophoblastic disease. Association of PSTT and nephrotic syndrome is exceedingly rare and has been described in 8 cases thus far. In all cases hysterectomy was performed within months after onset of symptoms, leading to immediate remission of nephrotic syndrome, except for one patient who died of complications of PSTT. Case: We describe the history of a woman in which PSTT was discovered years after onset of nephrotic syndrome. Kidney biopsy revealed lupus-like mesangiocapillary nephritis and over time the patient developed additional symptoms mimicking systemic lupus erythematosus (SLE). Discussion: We provide an overview of the literature on this clinical entity and elaborate on its pathophysiology. In addition, we reflect on the phenomenon of anchoring bias, that led physicians to assume the patient had SLE without questioning this diagnosis in the light of the unexplained finding of increased tumor markers.

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A Rare Gestational Trophoblastic Disease: Placental Site Trophoblastic Tumor

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.485 ◽

2016 ◽

Author(s):

Senem Yaman Tunç ◽

Elif Ağaçayak ◽

Mehmet Sait İçen ◽

Serdar Başaranoğlu ◽

Mehmet Sıddık Evsen ◽

...

Keyword(s):

Uterine Cavity ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Gestational Trophoblastic Disease ◽

Placental Site Trophoblastic Tumor ◽

Trophoblastic Tumor ◽

Trophoblastic Cells ◽

Placental Site ◽

Gestational Trophoblastic Diseases ◽

Abnormal Vaginal Bleeding

<p>Placental site trophoblastic tumor (PSTT) is a highly rare form of gestational trophoblastic diseases that arise from intermediate trophoblastic cells. By presenting this case, we aimed to review the treatment and diagnosis, approach to PSTT.<br />A 31-year-old (G2P1A1L1) patient had abnormal vaginal bleeding. Serum ß-HCG was 5.82 mIU/ml and the transvaginal USG detected a polypoid mass in uterine cavity. Probe curettage was performed. Histopathologic specimens were confirmed as PSTT. No metastasis was detected. A total abdominal hysterectomy was performed.<br />PSTT is a rare tumor. In contrast to other trophoblastic tumors, PSTT produces a small amount of ß-HCG and it is relatively insensitive to chemotherapy. Adjuvant chemotherapy is suggested to follow surgical treatment in the cases with metastasis.</p>

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Placental site trophoblastic tumor: report of four cases and review of literature

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2006.00774.x ◽

2007 ◽

Vol 17 (1) ◽

pp. 258-262 ◽

Cited By ~ 19

Author(s):

B. Piura ◽

A. Rabinovich ◽

M. Meirovitz ◽

R. Shaco-Levy

Keyword(s):

Gestational Trophoblastic Disease ◽

Primary Treatment ◽

Placental Site Trophoblastic Tumor ◽

Review Of Literature ◽

Trophoblastic Tumor ◽

Placental Site ◽

Disease Extension ◽

Mitotic Figures ◽

Β Hcg ◽

The One

Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic disease that originates from the implantation site intermediate trophoblast. We report four patients with PSTT and review pertinent literature. Three patients presented with disease confined to the uterus and one patient with disease extension beyond the uterus. Antecedent pregnancy was full-term pregnancy in three patients and termination of a 21-week pregnancy in one patient. Interval from the antecedent pregnancy was <1 year in three patients and 13 years in one patient. Primary treatment was simple hysterectomy in three patients and radical hysterectomy in one patient. Overall, three patients received chemotherapy; one had EP/EMA as adjuvant chemotherapy, one had EMA/CO for rising levels of serum β-hCG and one had BEP then VIP for recurrent disease. The three patients with disease confined to the uterus have remained after treatment alive and with no evidence of disease, whereas the one patient with disease extension beyond the uterus died of disease despite surgery and aggressive chemotherapy. It is concluded that disease extension beyond the uterus is the most important adverse prognostic factor. Other adverse prognostic factors are interval from antecedent pregnancy >2 years, age >40 years, and mitotic count >5 mitotic figures/10 high-power fields. Because of the relative insensitivity to chemotherapy, hysterectomy is the mainstay of treatment. EP/EMA seems to be the most effective first-line chemotherapy available to date for metastatic and relapsing PSTT

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Comparison of hydrosonography and transvaginal ultrasonography in the detection of intracavitary pathologies in women with abnormal uterine bleeding

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200401000-00007 ◽

2004 ◽

Vol 14 (1) ◽

pp. 57-63 ◽

Cited By ~ 2

Author(s):

M. A. Guven ◽

T. Bese ◽

F. Demirkiran

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transvaginal Sonography ◽

Normal Endometrium ◽

Pathologic Findings ◽

History Of ◽

Sensitivity Specificity

BackgroundThe aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding.Study designProspective, randomized, and unblinded study.Material and methodsA total of 197 women (n = 130 premenopausal and n = 67 postmenopausal) aged between 23 and 71 years (mean age 45.7 ± 8.9) presenting with a history of abnormal uterine bleeding were included into the study. Hydrosonography was carried out by experienced gynecologists, on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure.ResultsThe surgical-pathologic examination confirmed normal physiologic endometrium in 50 (48%) of 104 women who were said to have normal endometrium on transvaginal sonography. Seventy (75%) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56, 68, 75, and 48%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 23 (30%) of 76 women who were said to have normal endometrium on hydrosonography. Among 121 women diagnosed of intracavitary pathologies on hydrosonography, 101 (81%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81, 73, 83, and 70%, respectively. Sensitivity and negative predictive value were significantly higher with hydrosonography. There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results.ConclusionHydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.

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Malignant postpartal gestational trophoblastic neoplasm: A rare appearance of equal ultrasonography and operative finding in uterine placental site trophoblastic tumor and choriocarcinoma

Vojnosanitetski pregled ◽

10.2298/vsp170222050m ◽

2020 ◽

Vol 77 (2) ◽

pp. 229-232

Author(s):

Rastko Maglic ◽

Sladjana Mihajlovic ◽

Bojana Ivic ◽

Predrag Jokanovic ◽

Aleksandar Dobrosavljevic ◽

...

Keyword(s):

Vaginal Delivery ◽

Chorionic Gonadotropin ◽

Histopathological Examination ◽

Uterine Bleeding ◽

Relevant Parameter ◽

Placental Site Trophoblastic Tumor ◽

Color Flow ◽

Trophoblastic Tumor ◽

Different Types ◽

Placental Site

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 admitted for uterine bleeding 11 months after vaginal delivery and histopathological examination confirmed PSTT. The second patient (admitted in January 2017), 27 years old, was admitted 4 months after vaginal delivery because of uterine bleeding. Histopathological examination confirmed choriocarcinoma. Conclusion. Considering the fact that malignant GTN can appear in different types, with different ultrasonography pictures, this report is significant because two distinctly different malignant GTN entities could appear with equal clinical manifestations and equal ultrasound pictures even when they may have very different course of the disease treatment and outcome. Such cases need correct diagnosis which may be reached only after immunohistochemical analysis. The ultrasound patterns, both in gray scale, color flow, and Doppler values, were almost equal in both cases and guided the diagnostic procedures to the final treatment, even regardless of their very different histopathology.

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Intramural ectopic pregnancy

Archive of oncology ◽

10.2298/aoo1002030l ◽

2010 ◽

Vol 18 (1-2) ◽

pp. 30-31

Author(s):

Biljana Lazovic ◽

Vera Milenkovic

Keyword(s):

Ectopic Pregnancy ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Elevated Serum ◽

Normal Pregnancy ◽

Primiparous Woman ◽

Histopathological Analysis ◽

Molar Pregnancy ◽

Gestational Trophoblastic Neoplasia ◽

History Of

Gestational trophoblastic neoplasia refers to a subset of gestational trophoblastic conditions characterized with persistently elevated serum ?-human chorionic gonadotropin, absence of a normal pregnancy, and a history of normal or abnormal pregnancies. We described a case of suspected ectopic molar pregnancy in a primiparous woman who had elevated ?-human chorionic gonadotropin and required chemotherapy to achieve remission. Final histopathological finding was ectopic pregnancy; no gestational trophoblastic neoplasia was found. This case stresses the importance of histopathological analysis in diagnosis of gestational trophoblastic neoplasia when ectopic pregnancy is present, considering that histopathological analysis is less sensitive for gestational trophoblastic neoplasia than for ectopic pregnancy.

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ECTOPIC PREGNANCY : A MAJOR CAUSE OF MATERNAL MORTALITY?

Journal of Nepal Medical Association ◽

10.31729/jnma.823 ◽

2003 ◽

Vol 42 (147) ◽

pp. 151-155

Author(s):

Rajshree Jha ◽

M Singh ◽

A Rana ◽

A Singh ◽

S Bastola

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Pelvic Surgery ◽

Transvaginal Sonography ◽

Pregnancy Risk ◽

Abdominal Tenderness ◽

Presenting Symptoms ◽

History Of

ABSTRACTSeventyeight cases of ectopic pregnancy were studied retrospectively at Tribhuvan University TeachingHospital during April 1993 - December 1996. The overall incidence of etopic pregnancy was 0.86% livebirths. Grandmultipara were found to be at a low risk for ectopic pregnancy. A history of infertility andprevious pelvic surgery were positive risk factors. The most common presenting symptoms were abdominalpain (90%), history of amenorrhoea (46%), abnormal uterine bleeding (40%). On examination adenexaltenderness (72%), abdominal tenderness (68%), pallor (53%) and cervical excitation (33%) were the mostfrequent findings. Adenexal mass was noted in 22% cases and in 35 % cases the size of the uterus could notbe assessed. Ultrasonography and transvaginal sonography proved to be valuable diagnostic aids. Twomaternal deaths (2.6 %) due to ectopic pregnancy occurred in the hospital during this period.Key Words: Ectopic pregnancy, risk factors, sonography.

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The role of the ultrasound examination in atypical placental site trophoblastic tumour differential diagnosis and management. A case report

Medical Ultrasonography ◽

10.11152/mu-3149 ◽

2021 ◽

Author(s):

Monica Mihaela Cirstoiu ◽

Maria Sajin ◽

Alexandru Baros ◽

Sorin Vasilescu ◽

Natalia Turcan

Keyword(s):

Differential Diagnosis ◽

Ultrasound Examination ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Unique Form ◽

Caesarean Scar ◽

Placental Site ◽

Slow Growing ◽

Trophoblastic Tumours

Placental site trophoblastic tumour (PSTT) is a very rare and unique form of gestational trophoblastic tumour, representing about 1-2% of all gestational trophoblastic tumours. Usually, the pattern is a slow growing nodule implicating the endometrium and myometrium, accompanied by abnormal uterine bleeding. Three ultrasound types of PSTT are described, but thereis no specific characteristic for diagnosis. We present the case of a patient with an atypical placental site trophoblastic tumour diagnosed two months after a caesarean scar pregnancy. In the presented case there are several particularities, such as the rapid growth and progression of the tumour, the limitation to the myometrium and the difficulty of the differential diagnosis and approach.

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