Abstract
Placental site trophoblastic tumor (PSTT) is a rare neoplasm that rises from intermediate trophoblasts and commonly presents with low and variable concentration of HCG immunoactivity in serum, which can be difficult to differentiate from early stage choriocarcinoma/gestational trophoblastic neoplasm (GTN) or quiescent gestational trophoblastic disease. PSTT can occur after a normal pregnancy, spontaneous abortion, termination of pregnancy, ectopic or molar pregnancy. There is a wide clinical spectrum of presentation and behavior ranging from a benign condition to an aggressive disease with fatal outcome. Nontrophoblastic malignancies such as germ cell tumors or other tumors secreting low HCG must also be considered in the differential diagnosis. Because treatments for these conditions are different, a means of differentiating PSTT from other diagnoses is important. Surgery is the cornerstone of treatment. Chemotherapeutic regimen should be EMA/CO for first line chemotherapy; EMA/EP should be used in EMA/CO refractory cases. This article reviews the literatures on this rare but fatal disease.
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References
Ajithkumar TV, Abraham EK, Rejnishkumar R, Minimole AL (2003) Placental site trophoblastic tumor. Obstet Gynecol, Surv 58:484–488
Anderson M, Russell P (eds) (2002) Pathology of the female reproductive tract. Churchill Livingstone, London, pp 771–73
Arato G, Fulop V, Degrell P, Szigetvari I (2000) Placental site trophoblastic tumor. Pathol Oncol Res 6:292–294
Armes J (1995) Placental site trophoblastic tumor, report of three cases and review of the literature. Int J Gynecol Cancer 5:241–9
Bagshawe KD, Rustin GJS (1995) In: Peckham M, Pinedo H, Veronesi U (eds) Oxford textbook of oncology. Oxford university press, Oxford, vol 1, pp 412–420
Begent RHJ (1995) Gestational trophoblastic tumors. In: Peckham M, Pinedo H, Veronesi U (eds) Oxford Textbook of oncology. Oxford university press, Oxford, vol 2, pp 1363–1378
Behtash N, Hasanzadeh M, Hanjani P (2004a) Complete remission of an unusual location of metastatic gestational trophoblastic neoplasia GTN: a case report. Cancer Ther 2:575–578
Behtash N, Ghaemmaghami F, Honar H, Riazi K, Nori A, Modares M, Mousavi A (2004b) Is normal B-HCG regression curve helpful in the diagnosis of persistent trophoblastic disease?. Int J Gynecol Cancer 14:980–983
Behtash N, Ghaemmaghami F, Hasansadeh M, Modares M, Mosavi A (2005) Long term remission of metastatic placental site trophoblastic tumor, case report and review of literature. World J Surg Oncol 3:34
Behtash N, Ansari S, Saravi F (2006) Successful pregnancy after localized resection of perforated uterus in choriocarcinoma and a literature review. IGCS 16:445–448
Bower M, Paradinas FJ, Fisher RA et al (1996) Placental site trophoblastic tumor, molecular analysis and clinical experience. Clin Cancer Res 2:897–902
Chang YL, Chang TC, Hsueh S, Huang KG et al (1999) Prognostic factors and treatment for placental site trophoblastic tumor, Report of 3 cases and analysis of 88 cases. Gynecol Oncol 73:216–222
Cole LA, Khanlian SA, Muller CY, Giddings A, Kohorn E, Berkowitz R (2006) Gestational trophoblastic disease: 3. Human chorionic gonadotropin-free B-subunit, a reliable marker of placental site trophoblastic tumors Gynecol Oncol 102:160–164
Disaia PJ, Creasman WT (2002) Gestationl trophoblastic disease. In: Disaia PJ, Creasman WT (eds). Clin Gynecol Oncol, 6th edn. Mosby yearbook, St Louis, pp 185–206
Eskstein RP, Paradinas FJ, Bagshawe KD (1982) Placental site trophoblastic tumor, a study of four cases requiring hysterectomy including one fatal case. Histopathol 6:211–226
Felmate CM, Genest DR, Wise L et al (2001) Placental site trophoblastic tumor, A 17 year experience at the New England trophoblastic disease center. Gyncol Oncol 82:415–419
Fisher RA, Paradinas FJ, New lands ES et al (1992) Genetic evidence that placental site trophoblastic tumor can originate from hydatiform mole or a normal conceptus. Br J Cancer 65:355–358
Fox H (1995) Tumors of endometrium. In: Fletcher CDM (ed). Diagnostic histopathology of tumors. Churchill Livingstone, Edinburgh; pp 456–496
Fukunaga M, Ushigome S (1993) Malignant trophoblastic tumor. Hum Pathol 24:1098–1106
Goldstein DP, Zanten P IV, Bernstein MR et al (1998) Revised FIGO staging for gestational trophoblastic tumors. Recommendations regarding therapy. J Reprod Med 43:37–43
Guvendag Guven ES, Guven S, Esinter I, Ayhan A, Kucukali T, Usubutun A (2004) Placental site trophoblastic tumor in a patient with brain and lung metastases. Int J Gynecol Cancer 14:558
Hoesketra AV, Keh P, Lurain JR (2004) PSTT, a review of 7 case and their implications for prognosis and treatment. J Reprod Med 49:447–52
Hopkins M, Neunez C, Murphy JR, Wentz WB (1985) Malignant placental site trophoblastic tumor. Obstet Gynecol 66:955–1005
Hui P, Parkash V, Perkins AS, Carcagiu ML (2000) Pathogenesis of placental site trophoblastic tumor may require the presence of a paternally derived X chromosome. Lab Invest 80:965–972
Ishi K, Suzuki F, Satio A et al (1984) Cytodiagnosis of placental site trophoblastic tumor, a report of two cases. Acta Cytol 42:745–750
Iwamoto H, Nara M, Minai M, Hirata S, Hoshi K (2003) Placental site trophoblastic tumor, P53 gene analysis. Eur J Gynecol Oncol 24:25–9
Kandall TC, Coukos G, Wheeler JE (2000) Prolonged remission of recurrent metastatic placental site trophoblastic tumor after chemotherapy. Gynecol Oncol 76:115–117
Kurman RJ (1991) The morphology, biology and pathology of intermediate trophoblast, a look back into the present. Hum Pathol 22:847–855
Kurman RJ, Main CS, Chen HC (1984) Intermediate trophoblasts. A distinctive form of trophoblast with specific morphological, biochemical and functional features. Placenta 5:349–370
Kurman RJ, Scully RE, Norris HJ (1976) Trophoblastic psudotumor of uterus, an exaggerated form of “syncytial endometritis”simulating a malignant tumor. Cancer 38:1214–1226
Larsen LG, Theilade K, Skibdted L et al (1991) Malignant placental site trophoblastic tumor. A case report and review of the literature. APMIS l23(Supp):138–145
Lathrop FC, Lauchalan S, Ramakrishna N et al (1988) Clinical characteristics of placental site trophoblastic tumor (PSTT). Gynecol Oncol 31:32–42
Marchand F (1985) Uber die sogenannten “decidualen” geschwuste im anschloss an normale Gebart, Abort, Blasenmole, und Extauterin Schwangerchaft. Monatsschr Geburtshilfe Gynaekol 1:419
Monclair T, Abeler VM, Kaern J, Walaas L, Zeller B, Hailstorm C (2002) PSTT in mother and child, first report of PSTT in infancy. Med Pediatr Oncol 38:187–191
Moore-Maxwell CA, Robbery SJ (2004) Placental site trophoblastic tumor arising from antecedent molar pregnancy. Gynecol Oncol 92:708–712
Muller-Hocker J, Obemitz N, Johannes A et al (1997) P53 gene product and EGF receptors are highly expressed in placental site trophoblastic tumor. Hum Pathol 28:1302–1306
Nagelberg SB, Rosen SW (1985) Clinical and laboratory investigation of a virilized woman with placental site trophoblastic tumor. Obstet Gynecol 65:527–534
Newlands ES, Bower M, Fisher RA, Paradinas FJ (1998) Management of PSTT. J Reprod Med 43:53–59
Newslands ES, Mulhlland PJ, Holden L, SeckI MJ, Rustin GJS (2000) Etoposide and Cisplatin/Etoposide, Methotrexate and Actinomycin D (EMA) chemotherapy for patients with high risk gestational trophoblastic tumors refractory to EMA/ Cyclophosphamid and Vincristin chemotherapy and patients with metastatic PSTT. J Clin Oncol 18:854–9
Papadopoulos AJ, Foskett M, Seckl MJ, MC Neish I et al (2002) Twenty-five years clinical experience with placental site trophoblastic tumors. J Reprod Med 47:460–464
Rhoton-Vlasak A, Wagner JM, Rutgers JL et al (1998) Placental site trophoblastic tumor, HPL and pregnancy associated major basic protein as immunohystologic markers. Hum Pathol 29:280–288
Shih IM, Kurman RJ (1998) Ki67 labeling index in the differential diagnosis of exaggerated placental site, placental site trophoblastic tumor and choriocarcinoma, a double immunohystochemical staining technique using Ki67 and Mel-CAM antibodies. Hum Pathol 29:27–33
Sumi Y, Ozaki Y, Shindoh N, Katayama H (1999) Placental site trophoblastic tumor, imaging findings. Radiate Med 17:427–30
Swisher E, Drescher CW (1998) Metastatic placental site trophoblastic tumor, long-term remission a patient treated with EMA/CO chemotherapy. Gynecol Oncol 68:62–65
Tsji Y, Tsubamoto H, Hori M, Ogasawara T, Koyama K (2002) Case of placental site trophoblastic tumor treated with chemotherapy followed by open uterine tumor resection to preserve fertility. Gynecol Oncol 87:303–307
Twiggs LB, Okagaki T, Philips GL, Stroemer JR, Adcock LL (1981) Trophoblastic pseudotumor–evidence of malignant disease potential. Gynecol Oncol 12:238–248
Xue WC, Guan XY, Ngan HY, Shen DH, Khoo US, Cheung AN (2002) Malignant placental site trophoblastic tumor, a cytogenetic study using comparative genomic hybridization and chromosome insitu hybridization. Cancer 94:238–248
Young RH, Scullt RE, Mecluskey RT (1985) A distinctive glomerular lesion complication (PSTT), report or two cases. Human Pathol 16:35–42
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Behtash, N., Karimi Zarchi, M. Placental site trophoblastic tumor. J Cancer Res Clin Oncol 134, 1–6 (2008). https://doi.org/10.1007/s00432-007-0208-y
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DOI: https://doi.org/10.1007/s00432-007-0208-y