Fertility sparing therapy in a patient with placental site trophoblastic tumor: a case report.
BACKGROUND
Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease (GTD) that is generally resistant to conventional chemotherapeutic treatment. Patients with localized disease are usually managed with hysterectomy.


METHODS
A 29-year-old female presented with vaginal bleeding and an elevated serum human chorionic gonadotropin (HCG). After initial observation, the patient experienced continued vaginal bleeding and a persistently elevated HCG. Therefore, she underwent a dilation and curettage and final pathology revealed PSTT. Since the patient desired future fertility, the patient received combination chemotherapy with etoposide, methotrexate, actinomycin-D followed by etoposide and cisplatin (EMA-EP). The patient had a complete response to chemotherapy and subsequently delivered a term infant 2 years after completion of therapy.


CONCLUSIONS
PSTT is thought to be a chemoresistant disease and the preferred method of treatment is hysterectomy or local uterine resection. However, combination chemotherapy is a reasonable option in a properly counseled patient who strongly desires future fertility.
Numnum
T Michael
TM
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham,618 19th Street South, OHB 538, Birmingham, AL 35249, USA. tmnumnum@yahoo.com
Kilgore
Larry C
LC
Conner
Michael G
MG
Straughn
J Michael
JM
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003475:Curettage; D003937:Diagnosis, Differential; D005260:Female; D005298:Fertility; D006801:Humans; D011247:Pregnancy; D018245:Trophoblastic Tumor, Placental Site / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy