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Liu W, Zhao W, Huang X. Outcomes and prognostic factors of placental-site trophoblastic tumor: a retrospective study of 58 cases. Arch Gynecol Obstet 2022; 306:1633-1641. [DOI: 10.1007/s00404-022-06502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/28/2022] [Indexed: 11/02/2022]
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Clark M, Tchrakian N, Clarke B, Metser U, Bouchard-Fortier G. Placenta increta mimicking placental site trophoblastic tumor. Int J Gynecol Cancer 2021; 31:1481-1485. [PMID: 34725244 DOI: 10.1136/ijgc-2021-002988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Mitchell Clark
- Gynecologic Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Blaise Clarke
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Ur Metser
- Medical Imaging, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Joneborg U, Coopmans L, van Trommel N, Seckl M, Lok CAR. Fertility and pregnancy outcome in gestational trophoblastic disease. Int J Gynecol Cancer 2021; 31:399-411. [PMID: 33649007 DOI: 10.1136/ijgc-2020-001784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 12/28/2022] Open
Abstract
The aim of this review is to provide an overview of existing literature and current knowledge on fertility rates and reproductive outcomes after gestational trophoblastic disease. A systematic literature search was performed to retrieve all available studies on fertility rates and reproductive outcomes after hydatidiform mole pregnancy, low-risk gestational trophoblastic neoplasia, high- and ultra-high-risk gestational trophoblastic neoplasia, and the rare placental site trophoblastic tumor and epithelioid trophoblastic tumor forms of gestational trophoblastic neoplasia. The effects of single-agent chemotherapy, multi-agent including high-dose chemotherapy, and immunotherapy on fertility, pregnancy wish, and pregnancy outcomes were evaluated and summarized. After treatment for gestational trophoblastic neoplasia, most, but not all, women want to achieve another pregnancy. Age and extent of therapy determine if there is a risk of loss of fertility. Single-agent treatment does not affect fertility and subsequent pregnancy outcome. Miscarriage occurs more often in women who conceive within 6 months of follow-up after chemotherapy. Multi-agent chemotherapy hastens the natural menopause by three years and commonly induces a temporary amenorrhea, but in young women rarely causes permanent ovarian failure or infertility. Subsequent pregnancies have a high chance of ending with live healthy babies. In contrast, high-dose chemotherapy typically induces permanent amenorrhea, and no pregnancies have been reported after high-dose chemotherapy for gestational trophoblastic neoplasia. Immunotherapy is promising and may give better outcomes than multiple schedules of chemotherapy or even high-dose chemotherapy. The first pregnancy after immunotherapy has recently been described. Data on fertility-sparing treatment in placental site trophoblastic tumor and epithelioid trophoblastic tumor are still scarce, and this option should be offered with caution. In general, patients with gestational trophoblastic neoplasia may be reassured about their future fertility and pregnancy outcome. Detailed registration of high-risk gestational trophoblastic neoplasia is still indispensable to obtain more complete data to better inform patients in the future.
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Affiliation(s)
- Ulrika Joneborg
- Department of Pelvic Cancer, Karolinska University Hospital, Karolinska Institute Department of Women's and Children's Health, Stockholm, Sweden
| | - Leonoor Coopmans
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Nienke van Trommel
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Michael Seckl
- Department of Medical Oncology, Hammersmith Hospitals; Imperial College London, London, Pennsylvania, UK
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
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Ngu SF, Ngan HYS. Surgery including fertility-sparing treatment of GTD. Best Pract Res Clin Obstet Gynaecol 2020; 74:97-108. [PMID: 33127305 PMCID: PMC7547826 DOI: 10.1016/j.bpobgyn.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023]
Abstract
Gestational trophoblastic disease (GTD) consists of a spectrum of diseases, including hydatidiform moles, invasive mole, metastatic mole, choriocarcinoma, placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). GTD is a relatively uncommon disease occurring in women of reproductive age, with high cure rates. Primary treatment of hydatidiform moles includes uterine evacuation, followed by close monitoring of serial hCG levels to detect for post-molar gestational trophoblastic neoplasia (GTN). In patients with GTN, the main therapy consists of chemotherapy, although some surgical procedures are important in selected patients to achieve curing. Hysterectomy is the mainstay treatment for PSTT or ETT and may be considered in selected patients for management of hydatidiform mole and malignant GTN especially in chemoresistant disease. Resection of metastatic lesions such as in the lung or brain can be considered in selected patients with isolated chemoresistant tumour. Surgical treatment of GTD will be discussed in this chapter.
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Affiliation(s)
- Siew-Fei Ngu
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong.
| | - Hextan Y S Ngan
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 6/F Professorial Block, 102 Pokfulam Road, Hong Kong.
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Hancock BW, Tidy J. Placental site trophoblastic tumour and epithelioid trophoblastic tumour. Best Pract Res Clin Obstet Gynaecol 2020; 74:131-148. [PMID: 33139212 DOI: 10.1016/j.bpobgyn.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023]
Abstract
Placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT) are the rarest subtypes of gestational trophoblastic disease (GTD). Their diagnosis is complicated and lacks specific and sensitive tumour markers. They are slow-growing tumours and can occur months to years after any type of antecedent pregnancy. The primary treatment for localised disease is hysterectomy. However, extra-uterine invasion and/or metastasis occur in about one-third of cases and still cause death in a small number. Most patients are young; hence, fertility preservation is a consideration. The major obstacle for prognosis is chemotherapy resistance. The current understanding of these tumours remains elusive and no randomized controlled trials have been done. Even those centres treating a large number of patients with GTD will infrequently manage PSTT/ETT. In this review, we assess progress in the understanding of the disease and discuss four main clinical challenges - establishing conformity of practice, devising a risk-adapted approach to clinical management, establishing long-term follow-up data and evaluating therapies for poor prognosis and multi drug-resistant patients.
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Affiliation(s)
| | - John Tidy
- Director, Sheffield Trophoblastic Disease Centre, UK
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6
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Jones BP, Vali S, Saso S, Garcia-Dominguez X, Chan M, Thum MY, Ghaem-Maghami S, Kaur B, García-Valero L, Petrucci L, Yazbek J, Vicente JS, Quiroga I, Marco-Jiménez F, Smith JR. Endometrial autotransplantation in rabbits: Potential for fertility restoration in severe Asherman's syndrome. Eur J Obstet Gynecol Reprod Biol 2020; 248:14-23. [PMID: 32171148 DOI: 10.1016/j.ejogrb.2020.03.011] [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] [Received: 07/31/2019] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Uterine transplantation is now considered a feasible treatment for women with absolute uterine factor infertility and has been successfully performed for a woman with Asherman's syndrome (AS). The endometrium is a clinically and histologically distinct entity from the surrounding myometrium. Endometrial transplantation (ETx) may offer a less invasive option, with less immunogenic impact, to restore fertility in women with severe AS. The objective of this study was to assess the feasibility of ETx by evaluating surgical and reproductive outcomes following endometrial autotransplantation in a rabbit model. STUDY DESIGN A longitudinal study assessing surgical, biochemical, radiological, reproductive and histological outcomes following endometrial autotransplantation in ten New Zealand white rabbits. RESULTS Ten procedures were performed, including 8 endometrial auto-transplants (ETx) and 2 endometrial resections (ER), to control against endometrial regeneration. Eight procedures were successful, whereas two rabbits from the ETx group died intra-operatively. Three rabbits were euthanised at 48, 72 and 96 h post-operatively to assess gross and histological appearances. Two rabbits, one from the ETx group and one from the ER group, died four weeks and eight weeks post-operatively. Three rabbits subsequently underwent two cycles of in-vitro fertilization. The first cycle resulted in an implantation rate of 57% in the un-operated uteri. In two rabbits who underwent ETx, an implantation rate of 28.6% was seen. In the second cycle, an implantation rate of 61.9 % (13 implantations) was observed in the control uteri. In the two ETx females, an implantation rate of 14.3 % was seen. No pregnancies were seen in either cycle in the animals who underwent ER. Despite successful implantations in both cycles in the ETx rabbits, no livebirths were achieved. Following death or euthanasia there was gross and microscopic evidence of viable endometrium following ETx, but not following ER. CONCLUSION This study has revealed, for the first time, the feasibility of ETx with gross and microscopic evidence of viable endometrium, and the demonstration of clinical pregnancies. Whilst further studies are essential, and the achievement of successful livebirths fundamental, ETx may offer a potential fertility restoring opportunity for women with severe, treatment refractory cases of AS.
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Affiliation(s)
- Benjamin P Jones
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, W12 0HS London, UK; Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK.
| | - Saaliha Vali
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, W12 0HS London, UK
| | - Srdjan Saso
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, W12 0HS London, UK; Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Ximo Garcia-Dominguez
- Institute of Science and Animal Technology (ICTA), Universitat Politècnica de València, C/Camino de vera s/n, 46022 València, Spain
| | - Maxine Chan
- Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Meen-Yau Thum
- Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK; Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, SW1W 8RH, UK
| | - Sadaf Ghaem-Maghami
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, W12 0HS London, UK; Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Baljeet Kaur
- Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK; Department of Histopathology, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Luís García-Valero
- Institute of Science and Animal Technology (ICTA), Universitat Politècnica de València, C/Camino de vera s/n, 46022 València, Spain
| | - Linda Petrucci
- Institute of Science and Animal Technology (ICTA), Universitat Politècnica de València, C/Camino de vera s/n, 46022 València, Spain
| | - Joseph Yazbek
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, W12 0HS London, UK; Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Jose S Vicente
- Institute of Science and Animal Technology (ICTA), Universitat Politècnica de València, C/Camino de vera s/n, 46022 València, Spain
| | - Isabel Quiroga
- The Oxford Transplant Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford, OX3 7LE, UK
| | - Francisco Marco-Jiménez
- Institute of Science and Animal Technology (ICTA), Universitat Politècnica de València, C/Camino de vera s/n, 46022 València, Spain
| | - J Richard Smith
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, W12 0HS London, UK; Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
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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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8
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Placental site trophoblastic tumor and epithelioid trophoblastic tumor: Clinical and pathological features, prognostic variables and treatment strategy. Gynecol Oncol 2019; 153:684-693. [PMID: 31047719 DOI: 10.1016/j.ygyno.2019.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 12/30/2022]
Abstract
Placental site trophoblastic tumor [PSTT] and epithelioid trophoblastic tumor [ETT] are the rarest gestational trophoblastic neoplasias, developing from intermediate trophoblast of the implantation site and chorion leave, respectively. PSTT and ETT share some clinical-pathological features, such as slow growth rates, early stage at presentation, relatively low βhCG levels and poor response to chemotherapy. The mortality rate ranges from 6.5% to 27% for PSTT and from 10% to 24.2% for ETT. Advanced stage, long interval between antecedent pregnancy and diagnosis, and presence of clear cells are the independent prognostic variables for PSTT, and they may be similar for ETT. Hysterectomy can represent the only therapy for early disease, whereas adjuvant chemotherapy should be reserved to patients with poor risk factors, such as an interval from the antecedent pregnancy >4 years, deep myometrial invasion or serosal involvement. Few cases of fertility-sparing treatment in young women have been reported. An individualized multidisciplinary approach, including chemotherapy and debulking surgery with abdominal and/or extra-abdominal procedures, is warranted for advanced disease. EP/EMA and TP/TE are the preferred regimens in this setting. Immunohistochemistry has sometimes shown expression of EGFR, VEGF, MAPK, PDGF-R and PD-L1, and therefore investigational studies on biological agents targeting these molecules are strongly warranted for chemotherapy resistant-disease.
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De Nola R, Schönauer LM, Fiore MG, Loverro M, Carriero C, Di Naro E. Management of placental site trophoblastic tumor: Two case reports. Medicine (Baltimore) 2018; 97:e13439. [PMID: 30508960 PMCID: PMC6283185 DOI: 10.1097/md.0000000000013439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Rosalba De Nola
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
| | - Luca Maria Schönauer
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
| | - Maria Grazia Fiore
- Department of Emergency and Organ Transplantation, Pathology Unit, University of Bari, Bari, Italy
| | - Matteo Loverro
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
| | - Carmine Carriero
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
| | - Edoardo Di Naro
- Interdisciplinary Department of Medicine, Gynecology and Obstetrics Clinic, University of Bari
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Lu B, Teng X, Fu G, Bao L, Tang J, Shi H, Lu W, Lu Y. Analysis of PD-L1 expression in trophoblastic tissues and tumors. Hum Pathol 2018; 84:202-212. [PMID: 30339966 DOI: 10.1016/j.humpath.2018.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/29/2018] [Accepted: 10/05/2018] [Indexed: 12/25/2022]
Abstract
The immune checkpoint proteins, programmed death receptor 1 (PD-1) and programmed death ligand 1 (PD-L1), are crucial for maintaining fetomaternal immune tolerance and immune escape in cancers. In this study, we performed a comprehensive immunohistochemical study of PD-L1 expression in a large cohort of trophoblastic tissues and tumors. We found that normal villi and hydatidiform moles showed a heterogeneous PD-L1 staining among trophoblast (strong in syncytiotrophoblast, moderate in intermediate trophoblast, and weak/negative in cytotrophoblast). Eleven exaggerated placental sites (100%) showed variable PD-L1 staining, whereas 7 (36.8%) of 19 placental site nodules/plaques were weakly positive for PD-L1 (P < .001). All gestational choriocarcinomas (CCs; n = 63), epithelioid trophoblastic tumors (n = 12), and placental site trophoblastic tumors (n = 41) were PD-L1 positive, with most showing strong staining. However, PD-L1 expression was lower in epithelioid trophoblastic tumors compared with placental site trophoblastic tumors and CCs (P = .004). Three presumably germ cell-derived pure CCs, the CC elements in 13 mixed germ cell tumors, and 4 gastric/rectal CCs were also positive for PD-L1, with widespread staining. The background nontrophoblastic tissues, such as endometrial glands, squamous cells, and adenocarcinomas, were PD-L1 negative. Western blot analysis showed that PD-L1 was expressed in all 3 trophoblastic cell lines. We conclude that PD-L1 is a sensitive but nonspecific marker for trophoblast and related tumors. The frequent strong PD-L1 expression suggests that immune checkpoint blockade could be a promising approach in treating trophoblastic tumors that merits further investigation.
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Affiliation(s)
- Bingjian Lu
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310006, China; Center for Uterine Cancer Diagnosis and Therapy of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310006, China.
| | - Xiaodong Teng
- Department of Surgical Pathology, the Affiliated First Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310006, China
| | - Guoxiang Fu
- Department of Surgical Pathology, the Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310006, China
| | - Lei Bao
- Department of Surgical Pathology, Shaoxing Women's Hospital, Shaoxing, Zhejiang Province 3123000, China
| | - Jinglong Tang
- Department of Surgical Pathology, the Affiliated Second Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310006, China
| | - Haiyan Shi
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310006, China
| | - Weiguo Lu
- Center for Uterine Cancer Diagnosis and Therapy of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310006, China; Department of Gynecologic Oncology, the Affiliated Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310006, China
| | - Yan Lu
- Center for Uterine Cancer Diagnosis and Therapy of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310006, China; The Institute of Translational Medicine, School of Medicine, Zhejiang University, Zhejiang Province 310006, China.
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11
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Clinical characteristics and outcomes of placental site trophoblastic tumor: experience of single institution in Korea. Obstet Gynecol Sci 2018; 61:319-327. [PMID: 29780773 PMCID: PMC5956114 DOI: 10.5468/ogs.2018.61.3.319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/21/2017] [Accepted: 08/25/2017] [Indexed: 11/16/2022] Open
Abstract
Objective Placental site trophoblastic tumor (PSTT) is the rarest form of gestational trophoblastic disease (GTD) and the optimum management is still controversial. In this study, we analyzed the clinical features, treatment, and outcomes of 6 consecutive patients with PSTT treated in our institution. Methods The electronic medical record database of Samsung Medical Center was screened to identify patients with PSTT from 1994 to 2017. Medical records for the details of each patient's clinical features and treatment were extracted and reviewed. This study was approved Institutional Review Board of our hospital. Results A total of 418 cases of GTD, 6 (1.4%) patients with PSTT were identified. The median age of the patients was 31 years. The antecedent pregnancy was term in all 5 cases with available antecedent pregnancy information and the median interval from pregnancy to diagnosis of PSTT was 8 months. The median titer of serum beta human chorionic gonadotropin (β-hCG) at diagnosis was 190.9 mIU/mL. Five (83.3%) patients presented with irregular vaginal bleeding and one (16.7%) had amenorrhea. All patients had disease confined to the uterus without metastasis at diagnosis and were successfully treated by hysterectomy alone. All of them were alive without disease during the follow-up period. Conclusion In this study, we observed low level serum β-hCG titer and irregular vaginal bleeding with varying interval after antecedent term pregnancy were most common presenting features of PSTT. In addition, we demonstrated hysterectomy alone was successful for the treatment of stage I disease of PSTT.
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12
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Rockall AG, Qureshi M, Papadopoulou I, Saso S, Butterfield N, Thomassin-Naggara I, Farthing A, Smith JR, Bharwani N. Role of Imaging in Fertility-sparing Treatment of Gynecologic Malignancies. Radiographics 2017; 36:2214-2233. [PMID: 27831834 DOI: 10.1148/rg.2016150254] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Treatments for gynecologic cancer usually result in loss of fertility due to surgery or radical radiation therapy in the pelvis. In countries with an established screening program for cervical cancer, the majority of gynecologic malignancies occur in postmenopausal women. However, a substantial number of affected women are of childbearing age and have not completed their families. In these younger women, consideration of fertility preservation may be important. This article describes the fertility-sparing treatment options that are currently available and outlines the role of imaging in the selection of eligible patients on the basis of a review of the literature. In the setting of cervical cancer, magnetic resonance (MR) imaging is used to delineate the size, position, and stage of the tumor for selection of patients who are suitable for radical trachelectomy. In patients with solitary complex adnexal masses, diffusion- and perfusion-weighted MR imaging sequences are used to categorize the likelihood of invasive or borderline malignancy for consideration of unilateral ovarian resection, with fertility preservation when possible. In patients with endometrial cancer, MR imaging is used to rule out signs of invasive disease before hormone therapy is considered. Imaging is also used at patient follow-up to detect recurrent disease; however, evidence to support this application is limited. In conclusion, imaging is an essential tool in the care of patients with gynecologic malignancies who are considering fertility-preserving treatment options. ©RSNA, 2016.
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Affiliation(s)
- Andrea G Rockall
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Mahrukh Qureshi
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Ioanna Papadopoulou
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Srdjan Saso
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Nicholas Butterfield
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Isabelle Thomassin-Naggara
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Alan Farthing
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - J Richard Smith
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
| | - Nishat Bharwani
- From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.)
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Chiofalo B, Palmara V, Laganà AS, Triolo O, Vitale SG, Conway F, Santoro G. Fertility Sparing Strategies in Patients Affected by Placental Site Trophoblastic Tumor. Curr Treat Options Oncol 2017; 18:58. [PMID: 28840513 DOI: 10.1007/s11864-017-0502-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OPINION STATEMENT Placental site trophoblastic tumor (PSTT) is the least common and the most ambiguous gestational trophoblastic tumor. Presentation of PSTT may occur in the course of gestation or from 1 week to 14 years after a normal or an abnormal pregnancy (mole, ectopic pregnancy, abortion). The indicators of aggressive behavior for this tumor are not well established. Due to the rarity of this disease that usually affects women of childbearing potential, we aimed to review the current literature, to identify risk factors and the best conservative therapeutic choices among the cases described. We performed a systematic literature search of articles in English language, published from 1996 to 2017 and indexed in PubMed and Scopus. Based on selective inclusion/exclusion criteria, we considered eight papers eligible for the review. Five were case reports and three were retrospective studies. We extracted and organized data into three different categories depending on the main treatment used. A total of 12 cases were treated with laparotomy; in 5 cases, the treatment was not curative. Therefore, a total abdominal hysterectomy was needed. Five cases were treated successfully with a minimally invasive approach, 2 with uterine evacuation, 2 with hysteroscopic resection, and 1 with a combined hysteroscopic/laparoscopic resection. Only 1 case treated with exclusive chemotherapy proved curative for the patient. Preservation of fertility in PSTT patients of childbearing age should be considered and as showed by the abovementioned studies, is a possible and safe therapeutic choice. Laparotomy for local uterine resection with the modified Strassman approach could be offered in patients at clinical stage 1 that are very motivated to retain fertility, extensively informing the patient of the risks and benefits related to this choice.
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Affiliation(s)
- Benito Chiofalo
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Vittorio Palmara
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Onofrio Triolo
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Francesca Conway
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Santoro
- Department of Biomedical and Dental Sciences and Morpho-Functional Images, University of Messina, 1st floor Biologic Tower, Messina, Italy.
- Department of Biomedical and Dental Sciences and Morpho-Functional Images, A.O.U. Policlinic "G. Martino", 1st floor Biologic Tower, Via Consolare Valeria, 98125, Messina, Italy.
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Horowitz NS, Goldstein DP, Berkowitz RS. Placental site trophoblastic tumors and epithelioid trophoblastic tumors: Biology, natural history, and treatment modalities. Gynecol Oncol 2016; 144:208-214. [PMID: 27789086 DOI: 10.1016/j.ygyno.2016.10.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022]
Abstract
Placental site (PSTT) and epithelioid trophoblastic tumor (ETT) are rare types of gestational trophoblastic neoplasia (GTN) that arise from intermediate trophoblast. Given that this cell of origin is different from other forms of GTN, it is not surprising that the clinical presentation, tumor marker profile, and treatment paradigm for PSTT and ETT are quite different as well. The mainstay for therapy for stage I PSTT and ETT is hysterectomy with adjuvant chemotherapy reserved for those presenting greater than four years from the antecedent pregnancy. Surgery is also important for metastatic disease. There is no standardized chemotherapy regimen for advanced stage disease but often consists of a platinum-containing combination therapy, usually EMA-EP or TE/TP. Despite its rarity, PSTT and ETT account for a disproportionate percentage of mortality from GTN likely resulting from their relative chemotherapy resistance. Novel therapeutic modalities therefore are needed to improve the outcomes of women with advanced stage or resistant PSTT and ETT.
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Affiliation(s)
- Neil S Horowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA 02115, United States
| | - Donald P Goldstein
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA 02115, United States
| | - Ross S Berkowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA 02115, United States.
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Historical, morphological and clinical overview of placental site trophoblastic tumors: from bench to bedside. Arch Gynecol Obstet 2016; 295:173-187. [PMID: 27549089 DOI: 10.1007/s00404-016-4182-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Placental site trophoblastic tumor (PSTT) is a form of gestational trophoblastic disease that originates from the implantation of an intermediate trophoblast. It was described for the first time by Von F. Marchand in 1895 as belonging to chorioepithelioma sui generis, a pathological condition with many variations and a progressive degree of malignancy. METHODS We have conducted a literature review in MEDLINE about epidemiology, etiopathogenesis and clinical features of PSTT. Moreover, a case that occurred in our institution was reported. RESULTS Our research has highlighted that existing published data about PSTT are not uniform. The number of cases described in the literature has updated and the clinical features of selected "case series" of patients diagnosed with PSTT were showed. The etiopathogenesis was discussed. It was noted that current prognostic factors still allow important information regarding PSTT to be obtained, albeit fragmentary. CONCLUSIONS The lack of uniformity in data collection seen so far has limited full knowledge of PSTT. For this reason, we suggest a model (PSTT model) that collects and unifies PSTT evidence as this would be useful to identify worldwide precise prognostic factors, which are still lacking. When PSTT is diagnosed, the proper procedure seems to be total hysterectomy, with sampling of pelvic lymph nodes and ovarian conservation. For advanced-stage diseases, (stage III and IV) a combination of surgery and polychemotherapy is suggested.
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Placental site trophoblastic tumor: A review of 108 cases and their implications for prognosis and treatment. Gynecol Oncol 2016; 142:102-108. [DOI: 10.1016/j.ygyno.2016.05.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/24/2016] [Accepted: 05/07/2016] [Indexed: 11/22/2022]
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Zeng X, Liu X, Tian Q, Xue Y, An R. Placental site trophoblastic tumor: A case report and literature review. Intractable Rare Dis Res 2015; 4:147-51. [PMID: 26361566 PMCID: PMC4561244 DOI: 10.5582/irdr.2015.01013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 11/05/2022] Open
Abstract
Here, we report a case of a placental site trophoblastic tumor (PSTT) in a 36-year-old Chinese woman 10 months after a normal pregnancy. Two months postpartum, the woman presented with abnormal vaginal discharge and her condition was overlooked by her local hospital. The woman did not receive further attention until a mass with a heterogeneous echo was found in an ultrasound examination eight months postpartum. The final diagnosis was confirmed by histological examinations in conjunction with immunohistochemical studies. Since the patient had potential risk factors, she was successfully treated with a hysterectomy and peri- and post-operative chemotherapy. The latest follow-up (16 months after diagnosis) was uneventful, and the patient exhibited no signs of recurrence or metastasis.
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Affiliation(s)
- Xianling Zeng
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, China
| | - Xi Liu
- Department of Pathology, the First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, China
| | - Quan Tian
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, China
| | - Yan Xue
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, China
| | - Ruifang An
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, China
- Address correspondence to: Dr. Ruifang An, Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an 710061, China. E-mail:
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Zheng Y, Bao L, Ning Y, Lu X, Hua K, Yi X. Retrospective analysis of the clinicopathologic and prognostic characteristics of stage I placental site trophoblastic tumor in China. Int J Gynaecol Obstet 2014; 129:67-70. [DOI: 10.1016/j.ijgo.2014.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/09/2014] [Accepted: 12/12/2014] [Indexed: 11/26/2022]
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Atypical recurrence of a placental site trophoblastic tumor four years after hysterectomy for benign condition: Case report and review of literature. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 6:36-8. [PMID: 24371716 PMCID: PMC3862214 DOI: 10.1016/j.gynor.2013.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/23/2013] [Indexed: 11/24/2022]
Abstract
Rare case of PSTT limited to the vagina presenting eight years after last pregnancy and four years after hysterectomy Differential diagnosis with other vaginal tumors can be challenging but it is critical because behavior and management are different. Stage-adapted management is proposed and surgery is the mainstay treatment for localized disease.
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Abstract
A placental site nodule is a benign proliferation of intermediate trophoblasts from a previous gestation that failed to completely involute. It is a rare entity that is often asymptomatic and is usually found incidentally weeks or even years after the pregnancy. The most common location for placental site nodules is in the uterus within the endometrium and occasionally in the cervix, diagnosed by uterine curettings or hysterectomy. However, rare extrauterine cases have been documented and should be considered as a differential diagnosis when encountered in locations such as the fallopian tube. Here, we present a case of a 28-year-old woman with a history of spontaneous abortions who was found to have a placental site nodule of the fallopian tube after postpartum tubal ligation.
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Moutte A, Doret M, Hajri T, Peyron N, Chateau F, Massardier J, Duvillard P, Raudrant D, Golfier F. Placental site and epithelioid trophoblastic tumours: diagnostic pitfalls. Gynecol Oncol 2012; 128:568-72. [PMID: 23159816 DOI: 10.1016/j.ygyno.2012.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/03/2012] [Accepted: 11/08/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the clinical and histological pitfalls in the diagnosis of placental site trophoblastic tumours (PSTT) and epithelioid trophoblastic tumours (ETT), two rare types of gestational trophoblastic neoplasia (GTN). METHODS This retrospective, observational, study was carried out in the French Trophoblastic Disease Reference Centre, Lyon, between 2000 and 2011. Due to the many similarities in the diagnosis, treatment and prognosis of PSTT and ETT, these two types of tumour were investigated together. Twenty-two patients with PSTT or ETT were analysed. RESULTS The clinical presentation of these two types of tumour was irregular vaginal bleeding (55%) or amenorrhoea (27%), with a median plasma hCG level of 205IU/L. Seven of the 22 patients (32%) were initially misdiagnosed as an ectopic pregnancy. Median age at presentation was 35-years, with a median interval of 12months between the antecedent pregnancy and diagnosis of PSTT or ETT. The initial histological diagnosis was incorrect in 7/18 (39%) patients; there was a major disagreement with the referral pathologist in five of these seven patients (28%). CONCLUSIONS PSTT and ETT are the most difficult types of GTN to diagnose clinically and histologically. An incorrect diagnosis can lead to significant therapeutic deviations from the recommended first-line treatment, namely hysterectomy. Clinical and histological expertise is essential to avoid the pitfalls in the diagnosis of PSTT and ETT.
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Affiliation(s)
- Amandine Moutte
- Lyon 1 University, Department of Obstetrics and Gynaecology, Lyon Sud University Hospital, Lyon, France
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Saso S, Chatterjee J, Yazbek J, Thum Y, Keefe KW, Abdallah Y, Naji O, Lindsay I, Savage PM, Seckl MJ, Smith JR. A case of pregnancy following a modified Strassman procedure applied to treat a placental site trophoblastic tumour. BJOG 2012; 119:1665-7. [DOI: 10.1111/j.1471-0528.2012.03501.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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