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Bukar M, Kawuwa MB, Nggada HA, Pindiga HU, Malgwi A. Placental Site Trophoblastic Tumour Mimicking Placenta Previa. Niger Postgrad Med J 2024; 31:81-83. [PMID: 38321801 DOI: 10.4103/npmj.npmj_236_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
ABSTRACT We present a 42-year-old Nigerian woman who had three previous caesarean sections and is being managed conservatively for placenta previa. She underwent a caesarean hysterectomy on account of uncontrollable bleeding, and histopathology revealed a placental site trophoblastic tumour.
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Affiliation(s)
- Mohammed Bukar
- Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, Borno State, Nigeria
| | - Mohammed Bello Kawuwa
- Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, Borno State, Nigeria
| | - H A Nggada
- Department of Histopathology, University of Maiduguri Teaching Hospital, Borno State, Nigeria
| | - H U Pindiga
- Department of Histopathology, University of Maiduguri Teaching Hospital, Borno State, Nigeria
| | - Adamu Malgwi
- Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, Borno State, Nigeria
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Ramirez-Espinoza A, Vela I, Server L, Roudriguez-Celdrán JM, Chuliá MT, Quereda F. Placental-site trophoblastic tumor with bone metastasis: A diagnostic and therapeutic challenge. Gynecol Oncol Rep 2023; 50:101304. [PMID: 38033360 PMCID: PMC10685014 DOI: 10.1016/j.gore.2023.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/18/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023] Open
Abstract
Placental-site trophoblastic tumor (PSTT) is a rare pathological entity included in the spectrum of gestational trophoblastic neoplasia (GTN). It is a neoplasia with metastatic potential that, once metastasized, has poor prognosis because the tumor tends to be less sensitive to chemotherapy. We present a rare case of gestational trophoblastic neoplasia, in which hysterectomy for persistent gestational trophoblastic disease after hydatidiform mole, revealed a primary PSTT in the uterus. Subsequently, a slight persistent elevation of the beta fraction of human chorionic gonadotropin hormone (B-hCG) during follow-up revealed the presence of bone metastases. This location is not usual from this tumor, being even more rare the case of PSTT with isolated bone metastases. Metastasic foci were only identified with PET-CT since the usual diagnostic resources were not able to do it. Finally, it is also remarkable in our case that the treatment required the confluence of chemotherapy together with immunotherapy to achieve a favorable response.
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Affiliation(s)
| | - Irene Vela
- Department of Obstetrics and Gynecology, University Hospital of San Juan, Alicante, Spain
| | - Laura Server
- Department of Obstetrics and Gynecology, University Hospital of San Juan, Alicante, Spain
| | | | - María T. Chuliá
- Department of Pathology, University Hospital of San Juan, Alicante, Spain
| | - Francisco Quereda
- Department of Obstetrics and Gynecology, University Hospital of San Juan, Alicante, Spain
- “Miguel Hernández” University, Alicante, Spain
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Khoiwal K, Gill P, Chawla L, Agrawal S, Chaturvedi J. What is your diagnosis? J Turk Ger Gynecol Assoc 2023; 24:76-78. [PMID: 36919689 PMCID: PMC10019005 DOI: 10.4274/jtgga.galenos.2022.2022-2-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Kavita Khoiwal
- Department Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Poonam Gill
- Department Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Latika Chawla
- Department Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Shruti Agrawal
- Department Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Jaya Chaturvedi
- Department Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
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Strickland AL, Gwin K. Gestational Trophoblastic Disease- Rare, Sometimes Dramatic, and What We Know So Far. Semin Diagn Pathol 2022; 39:228-237. [DOI: 10.1053/j.semdp.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 11/11/2022]
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Trelis Blanes A, Matute Tobías L, Montero Balaguer B, López Agulló S, Perales Marín A. Tumor trofoblástico del lecho placentario: reporte de un caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Peixinho C, Almeida A, Bartosch C, Cruz Pires M. Placental site trophoblastic tumour: five challenges of patient clinical management. BMJ Case Rep 2021; 14:14/1/e238994. [PMID: 33509882 PMCID: PMC7845717 DOI: 10.1136/bcr-2020-238994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Placental site trophoblastic tumour is a rare form of gestational trophoblastic disease accounting for about 1%-2% of all trophoblastic tumours. Diagnosis and management of placental site trophoblastic tumour can be difficult.We report a case of a 30-year-old woman diagnosed with a placental site trophoblastic tumour and identify the challenges in diagnosis and treatment of this rare situation. The presenting sign was abnormal vaginal bleeding that started 3 months after delivery. Image exams revealed an enlarged uterus with a heterogeneous mass, with vesicular pattern, and the increased vascularisation serum human chorionic gonadotropin level was above normal range. The histological diagnosis was achieved through hysteroscopic biopsy. Staging exams revealed pulmonary micronodules. The patient was successfully treated with hysterectomy and chemotherapy. The latest follow-up (37 months after diagnosis) was uneventful, and the patient exhibited no signs of recurrence or metastasis.
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Affiliation(s)
- Catarina Peixinho
- Department of Gynecology and Obstetrics, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Amélia Almeida
- Department of Gynecology and Obstetrics, Centro Hospitalar do Médio Ave, Famalicão, Portugal
| | - Carla Bartosch
- Department of Pathology, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
| | - Mónica Cruz Pires
- Department of Gynecology, Instituto Portugues de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
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Chaves MM, Maia T, Cunha TM, Veiga VF. Placental site trophoblastic tumour: the rarest subtype of gestational trophoblastic disease. BMJ Case Rep 2020; 13:13/10/e235756. [PMID: 33040035 DOI: 10.1136/bcr-2020-235756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Placental site trophoblastic tumour (PSTT) is a very rare form of gestational trophoblastic disease that grows slowly, secretes low levels of beta-subunit of human chorionic gonadotropin (β-hCG), presents late-onset metastatic potential and is resistant to several chemotherapy regimens. Here, we report a case of PSTT in a 36-year-old woman who presented with amenorrhea and persistently elevated serum level of β-hCG after a miscarriage. Transvaginal ultrasound revealed a hypovascular ill-defined solid lesion of the uterine fundus and MRI showed a tumour infiltrating the external myometrium with discrete early enhancement and signal restriction on diffusion-weighted imaging. PSTT was suspected, and after endometrial biopsy by hysteroscopy and posterior hysterectomy, microscopic examination allowed the final diagnosis. The level of β-hCG dropped significantly in about a month after surgical treatment. Due to the rarity of PSTT, reporting new cases is crucial to improve the diagnosis and managing of these patients.
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Affiliation(s)
- Mariana M Chaves
- Radiology, Hospital do Divino Espirito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Tiago Maia
- Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - Vera Furtado Veiga
- Gynecology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
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Feng X, Wei Z, Zhang S, Du Y, Zhao H. A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors. Front Oncol 2019; 9:937. [PMID: 31850188 PMCID: PMC6893905 DOI: 10.3389/fonc.2019.00937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/06/2019] [Indexed: 02/05/2023] Open
Abstract
Placental site trophoblastic tumor (PSTT) is a rare type of gestational trophoblastic disease originating from the intermediate trophoblast. Compared with hydatidiform mole, invasive hydatidiform mole and choriocarcinoma, the diagnosis of PSTT is more complicated and lacks specific and sensitive tumor markers. Most PSTT patients demonstrate malignant potential, and the primary treatment of PSTT is hysterectomy. However, metastasis occasionally occurs and even causes death in a small number of PSTT patients. Most PSTT patients are young women hence fertility preservation is an important consideration. The major obstacle for PSTT patient prognosis is chemotherapy resistance. However, the current understanding of the pathogenesis of PSTT and clinical treatment remains elusive. In this review, we summarized the research progress of PSTT in recent years from three aspects: mechanism, clinical presentation, and treatment and prognosis. Well-conducted multi-center studies with sufficient sample sizes are of great importance to better examine the pathological progress and evaluate the prognosis of PSTT patients, so as to develop prevention and early detection programs, as well as novel treatment strategies, and finally improve prognosis for PSTT patients.
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Affiliation(s)
- Xuan Feng
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Zhi Wei
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Sai Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Yan Du
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Hongbo Zhao
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
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