Gestational trophoblastic neoplasia (GTN) represents the malignant end of the gestational trophoblastic disease spectrum and includes the more common types, invasive mole (IM) and choriocarcinoma (CC) and the rare types, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). This is a case of a 42-year-old, G2P2 (2002) patient who complained of left lower quadrant pain and a 1 year history of amenorrhea. Urine pregnancy test done just prior to the surgery revealed positive result. Pre-operative diagnosis was abdominopelvic mass mass probably Sarcoma, ovarian new growth probably benign, right. Patient underwent exploratory laparotomy, adhesiolysis, bilateral internal iliac artery ligation, total hysterectomy with bilateral salpingo-oophorectomy, targeted biopsy, appendectomy, JP drain insertion under epidural anesthesia. Final histopathologic and immunohistochemical diagnosis is Epithelioid Trophoblastic Tumor. Differential diagnoses, diagnostics, and therapeutic options are presented, with focus on the description of sonographic features.
Trophoblastic Tumor, Placental Site ; Gestational Trophoblastic Disease

Placental site trophoblastic tumor (PSTT) with uterine arteriovenous malformation (AVM) is a rare and potentially catastrophic occurrence. A high index of suspicion and immunohistochemistry secured the diagnosis. The use of appropriate imaging modalities led to the identification of the extent of the disease. Sequential planned management from neoadjuvant intensive chemotherapy, bilateral uterine artery embolization, and laparotomy, and coordinated among different medical disciplines resulted to a successful definitive treatment. Due to its relatively chemoresistant nature, hysterectomy is the mainstay of treatment. Adjuvant platinum-based intensive chemotherapy has been shown to improve overall survival in patients with metastatic disease and those with poor prognostic factors. This case of PSTT with a typical clinical profile was noteworthy due to the development of a significant AVM, a rare complication of PSTT. This case report included a review of treatment experiences as well as peculiarities that set PSTT apart from the more common gestational trophoblastic diseases.
Gestational Trophoblastic Disease ; Trophoblastic Tumor, Placental Site

We present a rare case of a 23‑year‑old female with intraperitoneal hemorrhage from uterine rupture as an uncommon presentation of placental site trophoblastic tumor (PSTT) after spontaneous abortion. A high index of suspicion with this clinical presentation and the use of appropriate diagnostic tools to arrive at a diagnosis can go a long way in decreasing the adverse outcome of this disease. The histopathological findings and immunohistochemical staining were helpful armamentaria for the confirmation of PSTT. The patient was successfully managed with primary hysterectomy and postoperative chemotherapy.
Gestational Trophoblastic Disease ; Trophoblastic Tumor, Placental Site ; Abortion, Spontaneous

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic tumor (GTT) that has different behavior in disease process. The hysterectomy is general for PSTT, but hysterectomy is undesirable for patients who wish to remain fertile. We planned to preserve fertility of a young patient by first administering EMA/CO (Etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) chemotherapy and then performing an open uterine surgery to remove residual tumor. The patient who attempted primary chemotherapy for PSTT must be undergone a hysterectomy because this conservative regimen showed sign of chemoresistance. We report a case of chemoresistant PSTT with trial to preserve fertility with a brief review of literatures.
Dactinomycin ; Drug Therapy ; Fertility ; Humans ; Hysterectomy ; Methotrexate ; Neoplasm, Residual ; Trophoblastic Neoplasms ; Trophoblastic Tumor, Placental Site*

Epithelioid trophoblastic tumor (ETT) is an unusual variant of gestational trophoblastic tumor that is closely related to choriocarcinoma and placental site trophoblastic tumor (PSTT) but shows different morphologic, immunohistochemical features. ETT grows in a nodular pattern compared with the infiltrative pattern of PSTT. Histologically the tumor is characterized by uniform population of mononucleate intermediate trophoblastic cells that resemble the trophoblastic cells in the chorionic laeve, so we called them "chorionic-type intermediate trophoblast". Immunohistochemically ETT was positive for cytokeratin, epithelial membrane antigen(EMA) and staining for human placental lactogen (hPL) and human chorionic gonadotrophin (hCG) was generally patchy, focal or negative whereas PSTT contained more hPL-positive cells than hCG-positive cells. ETT can behave in a malignant fashion such as distant metastasis. We experienced a case of ETT by clinical result, pathologic finding, so we report a case with brief literature review.
Choriocarcinoma ; Chorion ; Female ; Humans ; Keratins ; Membranes ; Neoplasm Metastasis ; Placental Lactogen ; Pregnancy ; Trophoblastic Neoplasms* ; Trophoblastic Tumor, Placental Site ; Trophoblasts*

Epithelioid trophoblastic tumor (ETT) is a very rare variant of gestational trophoblastic disease (GTD) which arises in reproductive age women with prior gestational history. Although abnormal vaginal bleeding is the most common symptom of ETT, there are no reported pathognomonic symptoms of ETT because of its rarity. ETT is similar to placental site trophoblastic tumor in terms of its slow growing characteristic and microscopic findings. Therefore, it could be misdiagnosed as placental site trophoblastic tumor or other types of GTD. Unlike other types of GTD, primary treatment of ETT is surgical resection because of its chemo-resistant nature. Accordingly, immunohistochemical staining is essential for accurate diagnosis and appropriate treatment. Here, we report a case of a 42-year-old hysterectomized woman with pelvic masses who suffered from abdominal pain. Through laparotomy, tumors were resected completely and they were diagnosed as ETT through immunohistochemical stain. This report provides more evidence about its clinical features, diagnosis, and treatment including a brief review of the literature.
Abdominal Pain ; Adult ; Diagnosis ; Female ; Gestational Trophoblastic Disease ; Humans ; Laparotomy ; Trophoblastic Neoplasms* ; Trophoblastic Tumor, Placental Site ; Trophoblasts* ; Uterine Hemorrhage

Placntal site trophoblastic tumor (PSTT) has been demonstrated to be a rare form of gestational trophoblastic tumor (GTT). Kurman (1976) et al recognized this disease as Trophoblastic pseudotumor and they thought it to be a benign exaggerated placental site reaction, but Twiggs et al (1981) reported a patient who died of widespread metastasis. Death has been reported in 2 of 14 cases due to metastatic disease, and therefore it is thought to have a malignant course and metastatic potential. It may occur at any age during the reproductive age but usually occurs in relation to second or subsequent pregnancies (a normal pregnancy, an abortion, or a molar pregnancy) rather than primipara. PSTT can metastasis to the brain, lung, liver, vagina and bladder. Larsen et al (1991) report metastasis rate about 10%. It produces little hCG and larger quantities of hPL. We experienced a case of PSTT after normal delivery, which was diagnosed and operated on in our hospital, and report this case with a brief review of literatures.
Brain ; Humans ; Liver ; Lung ; Molar ; Neoplasm Metastasis ; Pregnancy ; Trophoblastic Neoplasms ; Trophoblastic Tumor, Placental Site* ; Trophoblasts ; Urinary Bladder ; Vagina

Placental site trophoblastic tumor(PSTT) is a rare form of gestational trophoblastic disease. This rare tumor has the potential for metastasis and death. The average age at onset of PSTT is 28 years, and the second believed to be postmenopausal at the time of diagnosis. The most common presenting complaint is amenorrhea or abnormal vaginal bleeding and rare complaints are virilization, nephrotic syndrome, uterine rupture, etc. The treatment of choice is surgical removal of the tumor, that is total abdominal hysterectomy with both salpingo-oophorectomy. We present a case of placental site trophoblastic tumor associated with spontaneous uterine rupture that is rare complication with a brief review of literature.
Amenorrhea ; Diagnosis ; Female ; Gestational Trophoblastic Disease ; Hysterectomy ; Neoplasm Metastasis ; Nephrotic Syndrome ; Trophoblastic Tumor, Placental Site* ; Trophoblasts ; Uterine Hemorrhage ; Uterine Rupture ; Virilism

Gestational trophoblastic disease comprises a spectrum of interrelated conditions originating from the placenta. Malignant gestational trophoblastic disease refers to lesions that have the potential for local invasion and metastasis. This compromises many histological entities including hydatidiform moles, invasive moles, gestational choriocarcinomas, and placental site trophoblastic tumors. Before the advent of sensitive assays for human chorionic gonadotropin (hCG) and efficacious chemotherapy, the morbidity and mortality from gestational trophoblastic disease were substantial. Currently, with sensitive quantitative assays for beta-hCG and current approaches to chemotherapy, most women with malignant trophoblastic disease can be cured. We present a case of malignant gestational trophobalstic tumor with serum beta-hCG concentration over 1million IU/L that metastaze to the lungs and have a hyperthyroidism, but negative urine hCG testing. We report a case with a brief review of literatures.
Choriocarcinoma ; Chorionic Gonadotropin ; Drug Therapy ; Female ; Gestational Trophoblastic Disease ; Humans ; Hydatidiform Mole, Invasive ; Hyperthyroidism ; Lung ; Mortality ; Neoplasm Metastasis ; Placenta ; Pregnancy ; Trophoblastic Tumor, Placental Site ; Trophoblasts

Placental site trophoblstic tumor(PSTT) is a rare variant of trophoblastic disease. This type of trophoblastic tumor apparently exhibits different biologic behaviors as compared with choriocarcinoma. Diagnosis is made by finding a predominance of intermediate trophoblasts and absence of fetal tissue in the dilatation and currettage specimens. The intermediate trophoblastic cells produce relatively little beta-hCG and hPL and unlike other trophoblastic tumors, they are frequently resistant to chemotherapy1. But patients with metastasis frequently exhibit a progression of disease and die despite of aggressive multiagent chemotherapy. We report a case of PSTT, in which a 36-year-old woman presented with vaginal bleeding after D&CB at 14 weeks of pregnancy. Despite of blood transfusion, the patient was under shock state, and hysterectomy was done. After hysterectomy, the pathological diagnosis was PSTT confirmed by immunohistochemical study, and the result was strong positive for hPL & cytokeratin but weak positve for beta-hCG2.
Adult ; Blood Transfusion ; Choriocarcinoma ; Diagnosis ; Dilatation ; Drug Therapy ; Female ; Fetus ; Humans ; Hysterectomy ; Keratins ; Neoplasm Metastasis ; Pregnancy ; Shock ; Trophoblastic Neoplasms ; Trophoblastic Tumor, Placental Site* ; Trophoblasts ; Uterine Hemorrhage