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.
Department of Obstetrics and Gynecology, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan.
Takako
T
Ohmaru
Hiromitsu
H
Yamakawa
Sachiho
S
Netsu
Mitsuhiro
M
Nokubi
Ryo
R
Konno
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