Successful Treatment of Malignant Placental Site Trophoblastic Tumor with Combined Cytostatic–Surgical Approach: Case Report and Review of Literature

• Published in: Gynecologic oncology 1999-10, Vol.75 (1), p.164-169
• Main Authors: Janni, W., Hantschmann, P., Rehbock, J., Braun, S., Lochmueller, E., Kindermann, G.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Combined Modality Therapy; Diseases of mother, fetus and pregnancy; Female; Female genital diseases; gestational trophoblastic disease; Gynecology. Andrology. Obstetrics; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - secondary; Lung Neoplasms - surgery; Medical sciences; multiagent chemotherapy; placental site trophoblastic tumor; Pregnancy. Fetus. Placenta; Remission Induction; Trophoblastic Tumor, Placental Site - drug therapy; Trophoblastic Tumor, Placental Site - secondary; Trophoblastic Tumor, Placental Site - surgery; Tumors; Uterine Neoplasms - drug therapy; Uterine Neoplasms - pathology; Uterine Neoplasms - surgery; Vaginal Neoplasms - drug therapy; Vaginal Neoplasms - secondary; Vaginal Neoplasms - surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1006/gyno.1999.5550

Objective. Although rare among gestational trophoblastic diseases, the clinical relevance of malignant placental site trophoblastic tumor (PSTT) derives from its potential malignancy associated with early systemic tumor cell dissemination and manifestation of fatal metastases. Because of the low number of cases reported so far worldwide, several treatment strategies have been under consideration, which will be debated following this case report. Method. We present the case of a 33-year-old female with PSTT and metastases to the vagina and lung. A 9-month delay in accurate diagnosis was caused by a misinterpretation of her symptoms as signs of a spontaneous abortion. Specialized pathological examination finally led to the diagnosis of PSTT. Primary surgical treatment consisting of abdominal hysterectomy and unilateral salpingo-oophorectomy was followed by multiple resections of recurrent vaginal disease. After the completion of six cycles of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy, hCG titers stayed within the normal range. The patient is without evidence of disease 39 months after primary diagnosis. Result. This is the third case of documented long-term remission (>1 year) in metastatic PSTT after combined cryostatic–surgical treatment. Conclusion. Since the few previously reported cases with prolonged remission have been treated with the described combined cytostatic–surgical approach consisting of cytoreductive surgery and adjuvant chemotherapy, this approach may be recommended for metastatic PSTT.