Meshcheryakova M.Yu. Placental site trophoblastic tumor
- Authors: Verenikina E.V.1, Moiseenko T.I.1, Menshenina A.P.1, Nepomnyashchaya E.M.1, Adamyan M.L.1, Meshcheryakova M.Y.2
-
Affiliations:
- National Medical Research Centre for Oncology, Ministry of Health of Russia
- National Medica
- Issue: No 12 (2020)
- Pages: 223-229
- Section: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/249243
- DOI: https://doi.org/10.18565/aig.2020.12.223-229
- ID: 249243
Cite item
Open Access
Access granted
Abstract
Background. Placental site trophoblastic tumor (PSTT) is a nonvillous tumor originating from the placental part of trophoblast. This pathology was first described in 1976; only 300 cases of this disease are known to date. PSTT develops in reproductive-aged women and is noted for a relatively slow growth rate; morphologically, it is a monomorphic mass originating from intermediate trophoblast cells with signs of syncytiotrophoblast and cytotrophoblast. PSTT is characterized by a slow rise in blood β-hCG levels. The diagnosis of PSTT remains relevant: the rate of its misdiagnosis amounts to as much as 40%. In addition, there are problems with chemotherapy, which is why surgical treatment comes to the fore. Case report. In 2013, Patient A. aged 30 years had a second premature labor without complications. Her menstrual cycle did not resume after lactation cessation. Diagnostic curettage of the uterine cavity was performed in the National Medical Research Center for Oncology. Histological examination revealed intermediate trophoblast layers in the complete absence of chorionic villi. The histological findings and clinical presentations corresponded to Stage IPSTT. In this connection, an extended extirpation of the uterus with fallopian tubes was recommended. The β-hCG level decreased to 5.6 mIU/ml just 12 days after surgery and it was 0.06 mIU/ml one month later. Conclusion. The diagnosis of PSTT is accompanied by a problem in the medical treatment of this disease due to an extremely low sensitivity to chemotherapeutic agents. It is usually sufficient to carry out uterine extirpation if metastases are absent. In the clinical case demonstrated, the patient’s condition remained stable during the follow-up period of 44 months in the postoperative period and there were no signs of progression. Thus, early diagnosis is of great importance when the tumor is limited to the uterus and can be radically removed.
Full Text
About the authors
Ekaterina V. Verenikina
National Medical Research Centre for Oncology, Ministry of Health of Russia
Email: ekat.veren@yandex.ru
Cand. Med. Sci., Head of the Department of Oncogynecology
Tatiana I. Moiseenko
National Medical Research Centre for Oncology, Ministry of Health of Russia
Email: moiseenko48@inbox.ru
Dr. Med. Sci., Professor, chief researcher, Department of Reproductive Tumors
Anna P. Menshenina
National Medical Research Centre for Oncology, Ministry of Health of Russia
Email: anna.menshenina.00@mail.ru
Cand. Med. Sci., leading researcher, Department of Reproductive Tumors
Evgenia M. Nepomnyashchaya
National Medical Research Centre for Oncology, Ministry of Health of Russia
Email: rnioi-patology@yandex.ru
Dr. Med. Sci., Professor, leading researcher, Department of Anatomic Pathology
Meri L. Adamyan
National Medical Research Centre for Oncology, Ministry of Health of Russia
Email: adamyan.meri@mail.ru
researcher, Department of Reproductive Tumors
Milana Yu. Meshcheryakova
National Medica
Email: mesheryakovamilana@mail.ru
fellow doctor
References
- Bouquet de la Joliniere J., Khomsi F., Fadhlaoui A. Placental site trophoblastic tumor: a case report and review of the literature. Front Surg. 2014; 1: 31. https:// dx.doi.org/10.3389/fsurg.2014.00031.
- Lan C., Li Y., He J., Liu J. Placental site trophoblastic tumor: lymphatic spread and possible target markers. Gynecol. Oncol. 2010; 116(3): 430-7. https:// dx.doi.org/10.1016/j.ygyno.2009.10.056.
- Chiofalo B., Palmara V., Lagana A.S., Triolo O., Vitale S.G., Conway F. et al. Fertility sparing strategies in patients affected by placental site trophoblastic tumor. Curr. Treat. Options Oncol. 2017; 18(10): 58. https://dx.doi.org/10.1007/ s11864-017-0502-0.
- Colecchi C., Partemi S., Minelli N., Cascini F., Rossi R., Fulcheri E. et al. Placental Site Trophoblastic Tumor with lung metastases as cause of death in a young patient: a case report. Placenta. 2011; 32(12): 1060-3. https://dx.doi. org/10.1016/j.placenta.2011.10.006.
- Kurman R.J., Main C.S., Chen H.C. Intermediate trophoblast: a distinctive form of trophoblast with specific morphological, biochemical, and functional feature. Placenta. 1984; 5(4): 349-69. https://dx.doi.org/10.1016/s0143-4004(84) 80015-6.
- Huang F., Zheng W., Liang Q., Yin T. Diagnosis and treatment of placental site trophoblastic tumour - case report. Int. J. Clin. Exp. Pathol. 2013; 6(7): 1448-51.
- Lee H., Shin W Jang Y.J., Choi C.H., Lee J.W., Bae D.S. et al. Clinical characteristics and outcomes of placental site trophoblastic tumor: experience of single institution in Korea. Obstet. Gynecol. Sci. 2018; 61(3): 319-27. https:// dx.doi.org/10.5468/ogs.2018.61.3.319.
- Pai K., Kumar P., Vasudeva A. Primary cervical placental site trophoblastic tumor: a rare entity with an unusual presentation. J. Interdiscipl. Histopathol. 2013; 1(5): 286-9. https://dx.doi.org/10.5455/jihp.20130723051544.
- Stevens FT., Katzorke N., Tempfer C. Gestational trophoblastic disorders: an update in 2015. Geburtshilfe Frauenheilkd. 2015; 75(10): 1043-50. https:// dx.doi.org/10.1055/s-0035-1558054.
- DiSaia P.J., Creasman W.T., eds. Clinical gynecologic oncology. Philadelphia, PA: Elsevier Health Sciences; 2012:189-218.
- Zhao J., Lu W.G., Feng F.Z., Wan X.R., Liu J.H., Yi X.F. Placental site trophoblastic tumor: a review of 108 cases and their implications for prognosis and treatment. Gynecol. Oncol. 2016; 142(1): 102-8. https://dx.doi.org/10.1016/j. ygyno.2016.05.006.
- Seckl M.J., Sebire N.J., Fisher R.A., Golfier F., Massuger L., Sessa C. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2010; 24(6): 39-50. https://dx.doi. org/10.1093/annonc/mdt345.
- Mangili G., Lorusso D., Brown J., Pfisterer J., Massuger L., Vaughan M. et al. Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. Int. J. Gynecol. Cancer. 2014; 24(9, Suppl. 3): S109-16.
- Horowitz N.S., Goldstein D.P., Berkowitz R.S. Placental site trophoblastic tumors and epithelioid trophoblastic tumors: Biology, natural history, and treatment modalities. Gynecol. Oncol. 2017; 144(1): 208-14. https://dx.doi.org/10.1016Zj. ygyno.2016.10.024.
- Hyman D.M., Bakios L., Gualtiere G., Carr C., Grisham R.N., Makker V. et al. Placental site trophoblastic tumor: analysis of presentation, treatment, and outcome. Gynecol. Oncol. 2013; 129(1): 58-62. https://dx.doi.org/10.1016/j. ygyno.2012.12.029.
- Alexander A.L., Strohl A.E., Maniar K.P. Placental site trophoblastic tumor: Successful treatment of 14 cases. Gynecol. Oncol. 2018; 149(1): 198. https:// dx.doi.org/10.1016/j.ygyno.2018.04.449.
- Stichelbout M., Devisme L., Franquet-Ansart H., Massardier J., Vinatier D., Renaud F., Kerdraon O. SALL4 expression in gestational trophoblastic tumors: a useful tool to distinguish choriocarcinoma from placental site trophoblastic tumor and epithelioid trophoblastic tumor. Hum. Pathol. 2016; 54: 121-6. https://dx.doi.org/10.1016/j.humpath.2016.03.012.
- Santoro G., Lagana A.S., Micali A., Barresi V., Giacobbe V., Palmara V. Historical, morphological and clinical overview of placental site trophoblastic tumors: from bench to bedside. Arch. Gynecol. Obstet. 2017; 295(1): 173-87. https://dx.doi. org/10.1007/s00404-016-4182-y.
- Taylor F., Hancock B.W. Pharmacotherapy of placental site and epithelioid trophoblastie tumours. Expert Opin. Orphan Drugs. 2014; 3(1): 75-85. https:// dx.doi.org/10.1517/21678707.2015.997210.
- Cioffi R., Bergamini A., Gadducci A. Reproductive outcomes after gestational trophoblastic, neoplasia: a comparison between single-agent and multiagent chemotherapy: retrospective analysis from the MITO-9 group. Int. J. Gynecol. Cancer. 2018; 28(2): 332-7. https://dx.doi.org/10.1097/IGC.0000000000001175.
Supplementary files
