scholarly journals A Rare Gestational Trophoblastic Disease: Placental Site Trophoblastic Tumor

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>

Placental site trophoblastic tumor in a patient with secondary infertility and radiological findings consistent with a leiomyoma: a case report

2004 ◽  
Vol 14 (4) ◽  
pp. 694-696 ◽  
Author(s):  
K. Sakhel ◽  
A. Khalil ◽  
H. Kaspar ◽  
G. Azar ◽  
A. Mansour ◽  
...  
Keyword(s):  
Residual Tumor ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Filling Defect ◽  
Placental Lactogen ◽  
Placental Site Trophoblastic Tumor ◽  
Secondary Infertility ◽  
Trophoblastic Tumor ◽  
Dilation And Curettage ◽  
Placental Site

Placental site trophoblastic tumor (PSTT) is the rarest form of gestational trophoblastic diseases. We report a 40-year-old woman who presented initially after a year of secondary infertility with prolonged menstrual flow. Her last pregnancy ended in a suction dilation and curettage at 8 weeks' gestation for a missed abortion. A hysterosalpingogram revealed a solid 5 × 4.5 cm filling defect impinging on the endometrial cavity suggestive of a submucosal leiomyoma. A vaginal sonogram confirmed the findings. The patient underwent a laparotomy for excision of the 5-cm friable, necrotic mass that was performed by curetting. Pathologic examination of the specimen revealed sheets of intermediate trophoblastic cells characterized by large polyhedral cells and positive human placental lactogen staining consistent with PSTT. The patient eventually underwent total abdominal hysterectomy 4 weeks later with no evidence of residual tumor on histologic examination.

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

Lupus ◽  
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.

scholarly journals A Rare Case of Epithelioid Trophoblastic Tumor Presenting as Hematoma of a Caesarean Scar in the Lower Uterine Segment

Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 34
Author(s):  
Radomir Aničić ◽  
Aleksandar Rakić ◽  
Rastko Maglić ◽  
Dragutin Sretenović ◽  
Aleksandar Ristić ◽  
...  
Keyword(s):  
Normal Values ◽  
Color Doppler ◽  
Color Doppler Imaging ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Doppler Imaging ◽  
Peripheral Blood Flow ◽  
Trophoblastic Tumor ◽  
Trophoblastic Cells ◽  
Beta Human Chorionic Gonadotropin

Epitheliod trophoblastic tumor (ETT) account for only 1–2% of all the cases of gestational trophoblastic neoplasia (GTN), with a reported mortality rate of 10–24%. ETT is derived from chorionic type intermediate trophoblastic cells, which appears to be the reason for the only slightly elevated βhCG levels in these patients. We present a case of a 42-year-old patient who was admitted to the clinic eight months after Caesarean delivery, for irregular vaginal bleed with normal values of beta-human chorionic gonadotropin (βhCG). A 6 × 5 cm hematoma was evacuated from the isthmic uterine segment during the operation, and the histopathological exam of the tissue surrounding the hematoma revealed ETT. There were no metastatic lesions on the thoracal, abdominal, and pelvic CT. The second ultrasonographic exam revealed tumefaction of 5 cm at the site from the previous surgical procedure. Color Doppler imaging revealed no central nor peripheral blood flow. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy without adjuvant chemotherapy. This appears to be one of the shortest intervals from the anteceded gestational event until the diagnosis of this tumor, along with the absence of the significant ultrasonographic feature of the ETT-peripheral Doppler signal pattern. We underline that, even with normal values of βhCG, irregular vaginal bleeding following the antecedent gestational event should always arouse suspicion of GTN.

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

2007 ◽  
Vol 17 (1) ◽  
pp. 258-262 ◽  
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

Placental site trophoblastic tumor presenting as subaponeurotic metastasis

2005 ◽  
Vol 15 (2) ◽  
pp. 385-388
Author(s):  
Y. Aoki ◽  
H. Kase ◽  
K. Kashima ◽  
T. Yahata ◽  
K. Tanaka
Keyword(s):  
Actinomycin D ◽  
Gestational Trophoblastic Disease ◽  
Multiple Organ ◽  
Cranial Bone ◽  
Placental Site Trophoblastic Tumor ◽  
Local Irradiation ◽  
Tumor Removal ◽  
Trophoblastic Tumor ◽  
First Case ◽  
Placental Site

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

scholarly journals Laparoscopic hysterectomy as a treatment modality for gestational trophoblastic neoplasia - report of two cases

2021 ◽  
pp. 82-82
Author(s):  
Predrag Jokanovic ◽  
Aleksandar Rakic
Keyword(s):  
Hydatidiform Mole ◽  
Uterine Cavity ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Molar Pregnancy ◽  
Placental Site Trophoblastic Tumor ◽  
Variable Intensity ◽  
Partial Hydatidiform Mole ◽  
Trophoblastic Tumor ◽  
Placental Site

Introduction. Measurement of the serum levels of human chorionic gonadotropin?s beta isoform (bhCG) remains a crucial marker for diagnosing the GTN. Choriocarcinoma is commonly diagnosed due to extremely high levels of bhCG, but the presence of distant metastasis is not uncommon. Placental site trophoblastic tumor and epithelioid trophoblastic tumor remain some sort of an enigma because the levels of bhCG are usually low. Case report. A 44-year old patient, P2G3,was admitted to the Clinic under the suspicion of molar pregnancy, vaginal bleeding with variable intensity, and levels of bhCG of 1 837 787 mIU/mL. After two explorative curettages, bhCG saw a decline and a partial hydatidiform mole was diagnosed histopathologically. The patient was admitted to the Clinic on two occasions due to the increasing values of bhCG. Since bhCG failed to drop after two explorative curettages, hysteroscopic biopsy, one chemotherapy cycle, along with the suspicious ultrasonographic feature of metastatic GTN and the fact that the patient has refused further chemotherapy, a total laparoscopic hysterectomy was performed. Histopathological exam made the diagnosis of choriocarcinoma. A 50-year old patient, P2G4, was admitted to the Clinic under the ultrasonographic suspicion of molar pregnancy. She was complaining of pelvic discomfort and frequent urination. Initial levels of bhCG were 128 351 mIU/mL. Instrumental revision of the uterine cavity was performed and partial hydatidiform mole was diagnosed histopathologically. Because of the increasing levels of bhCG, ultrasonographical suspicion of the development of GTN in the uterine corpus, in accordance with patient?s age and the fact that she has regular menstrual cycles, total laparoscopic hysterectomy was performed, and a histopathological exam made the diagnosis of the placental site trophoblastic tumor. Conclusion. Laparoscopic hysterectomy could be a treatment of choice for the chemotherapy resistant GTNs but also for the choricarcinoma in patitent?s who have finished their reproductive activity and refuse to be treated with chemotherapeutics.

scholarly journals A rare case of placental site trophoblastic tumor

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.

CT and MR Findings of Placental Site Trophoblastic Tumor: A Report of Two Cases

1999 ◽  
Vol 40 (1) ◽  
pp. 137 ◽  
Author(s):  
Kang Hoon Lee ◽  
Kyung Sup Song ◽  
Jae Young Byun ◽  
Seog Nyeon Bae ◽  
Hyeon Sook Kim
Keyword(s):  
Placental Site Trophoblastic Tumor ◽  
Trophoblastic Tumor ◽  
Placental Site
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