Placental site trophoblastic tumor (PSTT) with multiple metastases and extremely poor prognosis.
Placental site trophoblastic tumor (PSTT) is a rare type of gestational trophoblastic disease. There is a wide clinical spectrum of presentation and behavior ranging from a benign condition to an aggressive disease with a fatal outcome. PSTT limited to the uterus is in a good prognosis group, but PSTT with metastasis is a lethal disease. We document a case of PSTT with multiple metastases and extremely poor prognosis. A 36-year-old woman had abnormal irregular vaginal bleeding 14 months after her third pregnancy and delivery. The mitotic count of the tumor cells was quite high (23/10 high-power fields). It would have been difficult to remove the tumor by surgery because of the tumor size and its invasion, so we suggested chemotherapy. We treated her with EMA/CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) as a first-line regimen. During the sixth cycle of EMA/CO, the disease became drug-resistant and she died 8 months after the first symptom. This was a rare case among documented patients with PSTT with metastasis, with the patient having short-term survival (<1 year). We conclude that a high mitotic count and atypical undifferentiated pathological features are significant poor prognostic factors for survival in PSTT.
Ohmaru
Takako
T
Department of Obstetrics and Gynecology, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan.
Yamakawa
Hiromitsu
H
Netsu
Sachiho
S
Nokubi
Mitsuhiro
M
Konno
Ryo
R
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001706:Biopsy; D002454:Cell Differentiation; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000008:administration & dosage; D008940:Mitotic Index; D009361:Neoplasm Invasiveness; D011247:Pregnancy; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D018245:Trophoblastic Tumor, Placental Site / Q000188:drug therapy / Q000556:secondary*; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000556:secondary*; D014750:Vincristine / Q000008:administration & dosage
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate