Placental Site Trophoblastic Tumor: A Study Of 13 Cases And Review Of The Literature

ObjectiveTo describe the clinical features, treatment and outcome of all patients with placental site trophoblastic tumour (PSTT) treated at the women's hospital school of medicine Zhejiang University and to compare these findings to other reports.MethodAll cases of PSTT at women's hospital school of medicine Zhejiang university database from January 1999 to August 2009 were reviewed. Data obtained included age at diagnosis, antecedent pregnancy (AP), interval from antecedent pregnancy until diagnosis, presenting features, presenting serum human chorionic gonadotrophin hormone (HCG) level, number and sites of metastases, treatment received, outcome and follow-up.Results13 patients with PSTT were identified from the database which incorporates a total of 1165 cases of gestational trophoblastic disease. Mean age of these 13 patients was 30years(range 25-37). The interval from pregnancy to diagnosis of 11 patients(84.6%) was less than 2 years. The antecedent pregnancy was a full-term, normal one in 11 cases (84.6%) and a missed abortion in 2 cases (15.4%). The range of serum HCG concentrations at diagnosis was 5.02-915.3, mean was 140.7IU/L,11 cases (84.6%) with levels< 200IU/L. HCG was raised in all cases with active disease.10 cases (76.9%) presented with irregular vaginal bleeding,3 cases (23.1%) presented with menelipsis or/and abnormal HCG.8 patients (61.5%) were cured by hysterectomy and the other 5 patients were cured by hysterectomy and EMA-CO chemotherapy (1 to 4 course of treatment). All these 13 patients with non-metastatic (Stage I) were all alive without recidivation by now.ConclusionPSTT is rare and accounts for 1.1% cases of gestational trophoblastic disease referred to our hospital. It has a variety of presenting features and its course is unpredictable. Metastatic involvement, long antecedent pregnancy interval and high mitotic count appear to be an adverse prognostic indicator. Hysterectomy remains the mainstay of treatment. Chemotherapy is indicated for patients with metastases and may be indicated when the mitotic index is>5 mitoses/10 HPF.