title: Spontaneous uterine perforation mimicking ectopic pregnancy as the initial presentation of placental site trophoblastic tumor.
abstract: Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease (GTD), with only 100 cases reported in the literature. Irregular vaginal bleeding has been reported to be the most common presenting symptom, however, spontaneous uterine perforation, mimicking ectopic pregnancy, as the initial presentation is extremely rare, and has not yet been reported in the Chinese literature. Herein, we report a 26-year-old female with PSTT complicating with uterine perforation that mimicked ectopic pregnancy as the initial presentation. She received wide excision of the uterine perforation margin only and now remains disease-free, 2 years after the operation. Reviewing the literature, while most cases of PSTT behave a benign fashion, some exhibit malignant behavior; surgery remains the mainstay of therapy. For patients whose disease is limited to the uterus, simple total abdominal hysterectomy is the treatment of choice. For patients with extensive or metastatic disease, cytoreductive surgery (total abdominal hysterectomy and resection of extrauterine tumor load) combined with chemotherapy should be applied. Etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA/CO) chemotherapy appears superior to other available chemotherapeutic regimens in the treatment
authors.affiliation: Division of Obstetrics/Gynecology, Armed Forces Taichung General Hospital, Taiwan, ROC. c332860@ms65.hinet.net
authors.forename: H W
authors.initials: HW
authors.lastname: Lin
authors.forename: C S
authors.initials: CS
authors.lastname: Shieh
authors.forename: L M
authors.initials: LM
authors.lastname: Chen
authors.forename: Y T
authors.initials: YT
authors.lastname: Yang
authors.forename: C P
authors.initials: CP
authors.lastname: Han
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis*; D018245:Trophoblastic Tumor, Placental Site / Q000175:diagnosis*; D014594:Uterine Neoplasms / Q000175:diagnosis*; D014595:Uterine Perforation / Q000209:etiology*