Placental site trophoblastic tumor arising from antecedent molar pregnancy.

Abstract

OBJECTIVE:

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease. Little is known about its pathogenesis and natural history.

METHODS:

This report describes two cases that arose in patients with documented complete hydatidiform moles and summarizes the antecedent prenatal histories of PSTTs based on a detailed Medline literature analysis.

CASES:

A 28-year-old, G(2)P(2) female had a live, 12-week gestation fetus and a coexisting molar pregnancy. Her hCG levels dropped promptly from 1.5 million to 23,273 IU/ml after termination, but rose shortly thereafter together with the onset of recurrent vaginal bleeding. Curettage revealed persistent mole. Persistently elevated hCG led to hysterectomy disclosing a fundal PSTT. The second case was that of a 48-year-old, G(2) woman who presented with symptoms of preeclampsia, hyperthyroidism, and elevated hCG. Curettage yielded a complete hydatidiform mole. Although the hCG level decreased for a short period, it soon increased despite treatment with methotrexate. A second curettage revealed a PSTT.

DISCUSSION:

A Medline literature analysis of PSTT, which consists almost entirely of individual cases and several small series, disclosed that PSTT is preceded in 61% of cases by normal term pregnancy, 12% molar pregnancy, 9% spontaneous abortion, 8% therapeutic abortion, and 3% with ectopic pregnancy, stillbirths or preterm delivery. No information is known in 7%. This report describes two additional cases of PSTT preceded by complete molar pregnancy.

CONCLUSIONS:

PSTT is a well recognized, but uncommon form of gestational trophoblastic disease. Although little is known about its pathogenesis, it is preceded not uncommonly by an abnormal pregnancy, including a molar pregnancy.

• Authors: Crystal A Moore-Maxwell, Stanley J Robboy
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 92 Issue 2 Pg. 708-12 (Feb 2004) ISSN: 0090-8258 [Print] United States
• PMID: 14766272 (Publication Type: Case Reports, Journal Article, Review)

Topics

• Adult
• Female
• Humans
• Hydatidiform Mole (complications, pathology)
• Middle Aged
• Pregnancy
• Trophoblastic Tumor, Placental Site (etiology, pathology)
• Uterine Neoplasms (etiology, pathology)