Analysis Of Diagnosis And Treatment Of Placental Site Trophoblastic Tumor

Objective:To analyze the clinical features, treatment, and outcome of placental site trophoblastic tumor (PSTT).Methods:From January2005to January2012,4patients were diagnosed as PSTT by histo-pathology and treated in Tianjin Central Hospital of Obstetrics&Gynecology. The history, clinical features, examination, lab test, treatment, and outcome of four cases were collected and studied retrospectively.Result:The mean age of patients included herein is31.7years (ranging from24-44years) and the median age is30years. Mean interval from antecedent pregnancy till the diagnosis was71months (ranging from11-216months). The largest interval of last pregnancy reported herein is18years. Three patients had antecedent pregnancy normal spontaneous full-term delivery and one patient had spontaneous abortion. The presenting symptoms were amenorrhea for2patients, vaginal bleeding after spontaneous abortion, and postpartum vaginal bleeding. The mean serum β-hCG level at presentation is566.3mIU/ml and the median serum β-hCG level at presentation is141.4mIU/ml (ranging from6.19mlU/ml to1976mlU/ml). Ultrasonography showed hyper vascular echogenic mass involved myometrium or endometrium in all of the cases. The diagnosis of the patient was established by histopathologic report obtained from endometrial curettage in all four patients. All four patients presented with disease confined to the uterus without distant metastasis. Two of the patient received hysterectomy among which one patient had subtotal hysterectomy and other patient had modified radical hysterectomy. Both of them received adjuvant EMA-CO chemotherapy. Two of the patient received fertility preservation treatment one received Dilatation and Curettage alternating with EMA-CO chemotherapy and other received hysteroscopic lesion excision with EMA-CO chemotherapy. Both of the patient’s was able to restore their fertility completely. All4patient received EMA/CO regimen chemotherapy for different cycles ranging from4to6cycles including2fixed consolidative cycles. All of the patients well responded to the chemotherapeutic agent and survived with no evidence of disease.Conclusion:PSTT is a rare type of GTD which can follow any type of pregnancy and presents variable characteristics. The most common symptoms of PSTT are abnormal vaginal bleeding and amenorrhea. The diagnosis is solely based on the histopathologic examination and is considered as gold standard diagnostic method. β-hCG is still the best available serum marker for monitoring the disease response to treatment and follow-up. Surgery is the cornerstone of treatment. Conservative management can be a possible treatment option in highly selected patients, desiring to preserve fertility but a regular follow-ups and a close monitoring of post-conservative therapy of serum P-hCG concentration is essential. Chemotherapeutic regime EMA/CO is highly effective in disease confined to the uterus. Adjuvant chemotherapy given to patient either after hysterectomy or after any conservative management can prolong remission and even cure.