Analysis On The Clinicopathological Characteristics Of Intermediate Trophoblastic Disease

ObjectiveThe study aims to conclude the clinicopathological characteristics of intermediate trophoblastic disease(ITD),especially intermediate trophoblastic tumor(ITT)?Materials and methodsThe first part:16ITD patients were from Qilu Hospital of Shandong University between January 2005 and December 2016.All cases were confirmed by pathological examination.Patients clinical datas were retrospectively analyzed according to four subtypes,including placental site trophoblastic tumor(PSTT),epithelioid trophoblastic tumor(ETT),placental site nodule(PSN)and exaggerated placental site(EPS).The second part:Clinical datas from relevant articles about PSTT and ETT,selected from Pubmed,Wanfang and CNKI databases between January 2010 and December 2016,combined with Qilu hospital datas,were analyzed by SPSS 19.0 software to illustrate the clinical and prognostic features of ITT(including PSTT and ETT).ResultsThe first part:There are 9 cases of PSTT,3 cases of ETT,2 cases of EPS,1 cases of PSN and one special type(PSTT complicated with cervical cancer and hydatidiform mole,PSTT&HM).The average age of ITD is 34.1 years old(range:22-51).The antecedent pregnancy includes term delivery(62.5%),molar pregnacy and abortion.The interval between the previous pregnancy and the diagnosis of ITD varies from 0 to 72 months with an average of 18.1 months.The main complaints are irregular vaginal bleeding(68.8%).Serum hCG peak varies from 0 to 5684 IU/1 with an average of 1316.18 IU/I,except for PSTT&HM(128500IU/1).There are two patients negative in hCG.All gynecological ultrosounds reveal abnormal echo,along with blood signal or not.PSTT can be stained by HPL and PLAP,negative in P63;yet,ETT shows positive results in P63,E-cad and CK.HCG and HPL expressed focally in all ITD.2 cases of PSTT preserved their fertility,and else cases of ITT underwent hysterectomy±adnexectomy.ITT with high risks(mitotic image>5/10HPF,the ivteval>2 years,metastases outside the uterus)had chemotherapy after operations,except 1 ETT with nephrotic syndrome.1 ETT was progessive during chemotherapy and gave up treatment,then died of encephalic metastases.12 cases of ITT followed up 38 months in average(range:3-102),all uneventful.One PSTT has borne twice after fertility preserving surgery.EPS and PSN is normal after the curettage.The second part:There are 62 cases of ITT,including 42 cases of PSTT and 19 cases of ETT and 1 case of PSTT&ETT.The average age of ITT is 35.9 years old(range:20-60).6%patients are postmenopausal,while 70%are below 40 years old.The number of gravidity is 2.7 on average(range:0-7),while the number of parturition is 1.4(range:0-3).The antecedent pregnancy includes term delivery(56.5%),abortion(21%),molar pregnacy(14.5%),premature delivery(1.6%)and unkown(6.4%).The interval between the previous pregnancy and the diagnosis of ITT varies from 2 to 444 months with an average of 63.5 months,but ETT>PSTT(P=0.01).The main complaints are irregular vaginal bleeding(71%),followed by amenorrhea(13%),abdominal pain(6%),edema(5%),an increased serum hCG in HM follow-up(3%),abnormal discharge(2%).77.4%patients have serum hCG below 1000IU/1.70.6%patients have lesions defined to the uterine body.77.4%patients are in phase FIGO I,unrelated with serum hCG(P=0.263).All patients underwent operations,including hysterectomy±salpingo-oophorectomy(89%)or merely lesions incision(11%).According to high risks and withdrawal indication(negative serum hCG at least continuous 3 weeks),15 cases have nonstandard treatment and 10 cases are unknown about chemotherapy.The follow-up ranges from 2 months to 102 months,with 90%patients uneventful.Age>40 years old(P=0.04)and nonstandard treatment(P=0.013)are dangerous prognostic factors.Fertility preserving shows little influence on the prognosis(P=0.342).Conclusion(1)ITD often happens to reproductive women,mainly with complaints about irregular vaginal bleeding and antecedent pregnancy of term delivery.The interval between the antecedent pregnancy and the diagnosis of ITD varies obviously.ITD has nagative or low raised serum hCG.Immunohistochemical test is crucial for the diagnosis of ITD.Operation is the first choice.(2)ETT is longger than PSTT on the interval between the previous pregnancy and the diagnosis.hCG can not reflect the tumor burdon and progression of ITT.ITT may need adjuvant chemotherapy according to high risks after hysterectomy±adnexectomy.Young patients can undergo fertility preserving operations after sufficient evaluaions.Clinical manifestation,gynecologial examinations and imaging examinations are necessary in follow-up.PSN and EPS only need curettage.(3)Most ITT are in phase FIGO I at preliminary diagnosis and have good prognosis.Age?40 years old and non-standard treatment indicate unfavorable prognosis.Fertility preserving operations do not affect the prognosis.(4)More researches are needed to investigate the clinical features,treatments and prognosis of ITT.