title: Chemoresistant placental site trophoblastic tumor with hilar lymph node metastasis: an unusual site of involvement.
abstract: BACKGROUND
  Placental site trophoblastic tumor (PSTT) is an uncommon variant of gestational trophoblastic diseases. In most cases, disease is confined to the uterus and treated with a simple hysterectomy. However, 30% of these patients will present with metastatic disease. Patients with metastases frequently have progression of disease and die despite aggressive multiagent chemotherapy.
  
  
  METHODS
  We present a case of 33-year-old female with PSTT and metastases to the hilar lymph nodes of the right lung. Primary surgical treatment consisting of abdominal hysterectomy and unilateral salpingo-oophorectomy was followed by six cycles of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy. After the completion of chemotherapy, betahCG titers stayed within normal range, but a repeated CT scan of chest revealed enlargement of the hilar lymph nodes. The patient underwent right thoracotomy with hilar lymph nodes resection. The resected nodules were pathologically consistent with primary PSTT.
  
  
  CONCLUSIONS
  In this case report, we have determined a PSTT with hilar region metastasis other than parenchyma of lung and confirmed the chemoresistant nature of tumor with the guidance of the previous reports.
authors.affiliation: Department of Obstetrics and Gynecology, Ankara Oncology Hospital, Mithatpaşa Caddesi No: 48/12 06420, Kizilay/Ankara, Turkey.
authors.forename: Jale
authors.initials: J
authors.lastname: Metindir
authors.forename: Işin
authors.initials: I
authors.lastname: Pak
authors.forename: Ciğdem
authors.initials: C
authors.lastname: Ozdilekcan
authors.forename: Evren
authors.initials: E
authors.lastname: Eren
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008727:Methotrexate / Q000008:administration & dosage; D011247:Pregnancy; D018245:Trophoblastic Tumor, Placental Site / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate