Placental site trophoblastic tumour: five challenges of patient clinical management

BMJ Case Rep. 2021 Jan 28;14(1):e238994. doi: 10.1136/bcr-2020-238994.

Abstract

Placental site trophoblastic tumour is a rare form of gestational trophoblastic disease accounting for about 1%-2% of all trophoblastic tumours. Diagnosis and management of placental site trophoblastic tumour can be difficult.We report a case of a 30-year-old woman diagnosed with a placental site trophoblastic tumour and identify the challenges in diagnosis and treatment of this rare situation. The presenting sign was abnormal vaginal bleeding that started 3 months after delivery. Image exams revealed an enlarged uterus with a heterogeneous mass, with vesicular pattern, and the increased vascularisation serum human chorionic gonadotropin level was above normal range. The histological diagnosis was achieved through hysteroscopic biopsy. Staging exams revealed pulmonary micronodules. The patient was successfully treated with hysterectomy and chemotherapy. The latest follow-up (37 months after diagnosis) was uneventful, and the patient exhibited no signs of recurrence or metastasis.

Keywords: cancer - see oncology; pathology; pregnancy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Chemotherapy, Adjuvant
  • Chorionic Gonadotropin / blood*
  • Cisplatin / therapeutic use
  • Consolidation Chemotherapy
  • Dactinomycin / therapeutic use
  • Etoposide / administration & dosage
  • Etoposide / therapeutic use
  • Female
  • Humans
  • Hysterectomy*
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / secondary
  • Lymph Node Excision*
  • Methotrexate / therapeutic use
  • Paclitaxel / administration & dosage
  • Pregnancy
  • Puerperal Disorders / blood
  • Puerperal Disorders / diagnostic imaging
  • Puerperal Disorders / pathology
  • Puerperal Disorders / therapy*
  • Salpingectomy
  • Trophoblastic Tumor, Placental Site / diagnostic imaging
  • Trophoblastic Tumor, Placental Site / pathology
  • Trophoblastic Tumor, Placental Site / secondary
  • Trophoblastic Tumor, Placental Site / therapy*
  • Uterine Neoplasms / blood
  • Uterine Neoplasms / diagnostic imaging
  • Uterine Neoplasms / pathology
  • Uterine Neoplasms / therapy*

Substances

  • Chorionic Gonadotropin
  • Dactinomycin
  • Etoposide
  • Paclitaxel
  • Cisplatin
  • Methotrexate

Supplementary concepts

  • PEA-M regimen