title: Placental site trophoblastic tumor: report of four cases and review of literature.
abstract: Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic disease that originates from the implantation site intermediate trophoblast. We report four patients with PSTT and review pertinent literature. Three patients presented with disease confined to the uterus and one patient with disease extension beyond the uterus. Antecedent pregnancy was full-term pregnancy in three patients and termination of a 21-week pregnancy in one patient. Interval from the antecedent pregnancy was <1 year in three patients and 13 years in one patient. Primary treatment was simple hysterectomy in three patients and radical hysterectomy in one patient. Overall, three patients received chemotherapy; one had EP/EMA as adjuvant chemotherapy, one had EMA/CO for rising levels of serum beta-hCG and one had BEP then VIP for recurrent disease. The three patients with disease confined to the uterus have remained after treatment alive and with no evidence of disease, whereas the one patient with disease extension beyond the uterus died of disease despite surgery and aggressive chemotherapy. It is concluded that disease extension beyond the uterus is the most important adverse prognostic factor. Other adverse prognostic factors are interval from antecedent pregnancy >2 years, age >40 years, and mitotic count >5 mitotic figures/10 high-power fields. Because of the relative insensitivity to chemotherapy, hysterectomy is the mainstay of treatment. EP/EMA seems to be the most effective first-line chemotherapy available to date for metastatic and relapsing PSTT.
authors.affiliation: Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology and Institute of Pathology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel. piura@bgumail.bgu.ac.il
authors.forename: B
authors.initials: B
authors.lastname: Piura
authors.forename: A
authors.initials: A
authors.lastname: Rabinovich
authors.forename: M
authors.initials: M
authors.lastname: Meirovitz
authors.forename: R
authors.initials: R
authors.lastname: Shaco-Levy
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007044:Hysterectomy; D011247:Pregnancy; D018245:Trophoblastic Tumor, Placental Site / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*