title: Placental site trophoblastic tumour: clinical features and management.
abstract: OBJECTIVE
  To describe the clinical features, treatment and outcome of all consecutive patients with placental site trophoblastic tumour (PSTT) treated at the Sheffield Trophoblast Centre and to compare these findings to other reports.
  
  
  METHODS
  All cases of PSTT on the Sheffield Trophoblastic Tumour Centre database from 1984 to 2004 were reviewed. Data obtained included age at diagnosis, antecedent pregnancy (AP), interval from antecedent pregnancy until diagnosis, presenting features, presenting serum human chorionic gonadotrophin hormone (hCG) level, number and sites of metastases, treatment received, outcome and follow-up.
  
  
  RESULTS
  Seventeen patients with PSTT were identified from the database which incorporates a total of 7489 cases of trophoblastic disease. Fourteen (70.6%) were more than 30 years old at presentation; 5 were over 40. The median interval from pregnancy to diagnosis was 18 months (range 6 months to 22 years). The outcome of antecedent pregnancy was a female in 11 out of the 13 patients where the sex was known. Eleven (70.6%) of patients presented with irregular vaginal bleeding, with or without a preceding period of amenorrhoea. All 8 patients with non-metastatic (Stage I) disease were alive and well after hysterectomy (6), chemotherapy alone (1) or hysterectomy and chemotherapy (1) whereas only 4 of 9 patients with metastatic (Stage III/IV) disease were alive and well after treatment with chemotherapy and hysterectomy.
  
  
  CONCLUSIONS
  PSTT is rare and accounts for 0.23% cases of gestational trophoblastic disease referred to this centre. It has a variety of presenting features and its course is unpredictable. Metastatic involvement and antecedent pregnancy interval greater than 4 years are poor prognostic factors. Hysterectomy is the primary mode of treatment in the majority of cases. However, chemotherapy can still play a major role when curative surgery is not feasible.
authors.affiliation: YCR Academic Unit of Clinical Oncology, The University of Sheffield, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, UK.
authors.forename: Ayman
authors.initials: A
authors.lastname: Hassadia
authors.forename: Alan
authors.initials: A
authors.lastname: Gillespie
authors.forename: John
authors.initials: J
authors.lastname: Tidy
authors.forename: Jan
authors.initials: J
authors.lastname: Everard R G N
authors.forename: Mike
authors.initials: M
authors.lastname: Wells
authors.forename: Robert
authors.initials: R
authors.lastname: Coleman
authors.forename: Barry
authors.initials: B
authors.lastname: Hancock
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D016896:Treatment Outcome; D018245:Trophoblastic Tumor, Placental Site / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*