1/13. Exaggerated placental site erroneously diagnosed as non-metastatic trophoblastic disease. A case report.BACKGROUND: Exaggerated placental site (EPS) is classified as a non-neoplastic trophoblastic lesion, and histologically it consists of endometrial and myometrial invasion of intermediate trophoblasts and syncytiotrophoblasts and it differs morphologically from placental site trophoblastic tumors and placental nodules. The purpose of this report is to increase physicians' awareness of this lesion. CASE: A 48-year-old woman with post-molar rising betahCG titers and a clinical diagnosis of non-metastatic trophoblastic disease underwent hysterectomy. Final histopathology showed exaggerated placental site--a lesion often unfamiliar to clinicians. CONCLUSION: It is suggested that operative hysteroscopy may be useful in the diagnosis and management of EPS.- - - - - - - - - - ranking = 1keywords = intermediate (Clic here for more details about this article) |
2/13. Old ectopic pregnancy remnants with morphological features of placental site nodule occurring in fallopian tube and broad ligament.Placental site nodule (PSN) is an asymptomatic benign proliferation of intermediate trophoblast from a previous gestation that failed to involute. It is most commonly found in the endometrium or endocervix; however, placental site nodule has recently been reported to occur at sites of ectopic gestation. This is the first case of PSN in the broad ligament in direct contact with the fallopian tube. The patient underwent surgery for an adenocarcinoma of the opposite tube. Microscopically and immunohistochemically, the lesion showed the characteristics of a proliferation of intermediate trophoblast.- - - - - - - - - - ranking = 2keywords = intermediate (Clic here for more details about this article) |
3/13. Malignant placental site trophoblastic tumor: a cytogenetic study using comparative genomic hybridization and chromosome in situ hybridization.BACKGROUND: Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasm composed predominantly of intermediate trophoblast. Most showed benign behavior whereas 10-15% of PSTTs were clinically malignant with later recurrence and metastasis. Currently, there are no reliable means to predict clinical outcome, and cytogenetic information is scanty. methods: The clinicopathologic features of two cases of malignant PSTT were analyzed. cytogenetic analysis was performed by comparative genomic hybridization (CGH) and chromosome in situ hybridization (CISH) using frozen tissue and paraffin embedded sections, respectively. RESULTS: Both patients were 32 years old at time of diagnosis. One patient with PSTT presented with menorrhagia, and the other presented with symptoms of missed abortion. Elevated serum human chorionic gonadotropin (HCG) was detected in both patients. Histologic examination showed the typical features of PSTT with high mitotic count (> 5/10 high-power fields). Ovarian and lung metastasis occurred in both patients. Immunohistochemical staining revealed an equal distribution of HCG and human placental lactogen. Cytogenetic studies by CISH showed that karyotypes of these two malignant PSTTs were diploid. Analysis of the tumor tissue by CGH did not show any changes in dna copy numbers. CONCLUSIONS: The authors' study indicated that the two metastasizing PSTTs had balanced diploid karyotype. The malignant behavior of PSTTs may be not related to the dna copy number changes. Such cytogenetic study may be useful in distinguishing metastatic PSTT from choriocarcinoma.- - - - - - - - - - ranking = 1keywords = intermediate (Clic here for more details about this article) |
4/13. Placental site trophoblastic tumor in a postmenopausal female--a case report.BACKGROUND: Placental site trophoblastic tumor (PSTT) is tumor of intermediate trophoblast, seen commonly in reproductive age group. CASE: A 63-year-old postmenopausal woman presented with vaginal discharge, occasional bleeding and a large uterine mass suspicious of malignancy. The uterus ruptured during hysterectomy. A large, necrotic and hemorrhagic tumor was seen in the endometrial cavity infiltrating through the myometrium into serosa. The tumor cells were large pleomorphic, polygonal with variable mitosis. The histological differential diagnosis included choriocarcinoma, epithelioid trophoblastic tumor, epithelioid leiomyosarcoma and poorly differentiated carcinoma. The tumor cells were positive for cytokeratin and beta-hCG and negative for smooth muscle antigen and HMB-45. The final histological diagnosis was PSTT. CONCLUSION: PSTT is rare in postmenopausal females. It is difficult to diagnose clinically as well as histologically.- - - - - - - - - - ranking = 1keywords = intermediate (Clic here for more details about this article) |
5/13. Placental site trophoblastic tumor in a late recurrence of a nonseminomatous germ cell tumor of the testis.Placental site trophoblastic tumor (PSTT) is a well-defined entity in the female genital tract. In the male genital tract, a single case of PSTT in the testis of a young boy has been reported. Despite its very rare occurrence, PSTT of the testis has been incorporated in the latest WHO classification of tumors of the male genital tract. In this article, a case of a PSTT in a late retroperitoneal recurrence of a testicular nonseminomatous germ cell tumor in an adult male patient is presented. The tumor was discovered due to an elevated serum level of beta-human chorionic gonadotropin 4 years after chemotherapy. Upon review of the primary testicular tumor, small foci of intermediate trophoblastic tumor cells were discerned. This case illustrates that tumor cells resembling intermediate trophoblastic cells may metastasize to regional retroperitoneal lymph nodes. Because of their resistance to chemotherapy, these cells may invade surrounding tissue in due time, acquiring the typical morphology of PSTT.- - - - - - - - - - ranking = 2keywords = intermediate (Clic here for more details about this article) |
6/13. Placental site trophoblastic tumor in a patient with brain and lung metastases.Placental site trophoblastic tumor is a rare neoplasm that arises from intermediate trophoblasts and shows diversity of biological behaviors, resulting in the absence of consistency in treatment modalities. A case of placental site trophoblastic tumor that extended to the cervix, with primary manifestation of amenorrhea and yellow foul-smelling vaginal discharge, is presented. Total abdominal hysterectomy was performed initially, and serial measurements of human chorionic gonadotropin levels were obtained. She was admitted with metastases to brain and lung 1.5 years after surgery. Combination chemotherapy (etoposide-methotrexate-dactinomycin/cyclophosphamide-vincristine) and radiotherapy were administered. There was no significant response to chemoradiotherapy. Despite changing chemotherapy regimen, she is still alive with progressive disease.- - - - - - - - - - ranking = 1keywords = intermediate (Clic here for more details about this article) |
7/13. Placental site trophoblastic tumor in a patient with secondary infertility and radiological findings consistent with a leiomyoma: a case report.Placental site trophoblastic tumor (PSTT) is the rarest form of gestational trophoblastic diseases. We report a 40-year-old woman who presented initially after a year of secondary infertility with prolonged menstrual flow. Her last pregnancy ended in a suction dilation and curettage at 8 weeks' gestation for a missed abortion. A hysterosalpingogram revealed a solid 5 x 4.5 cm filling defect impinging on the endometrial cavity suggestive of a submucosal leiomyoma. A vaginal sonogram confirmed the findings. The patient underwent a laparotomy for excision of the 5-cm friable, necrotic mass that was performed by curetting. Pathologic examination of the specimen revealed sheets of intermediate trophoblastic cells characterized by large polyhedral cells and positive human placental lactogen staining consistent with PSTT. The patient eventually underwent total abdominal hysterectomy 4 weeks later with no evidence of residual tumor on histologic examination.- - - - - - - - - - ranking = 1keywords = intermediate (Clic here for more details about this article) |
8/13. Neoplastic and non-neoplastic intermediate trophoblasts: an immunohistochemical and ultrastructural study.Five cases of non-molar trophoblastic disease including one placental site trophoblastic tumor (PSTT), two exaggerated placental sites and two choriocarcinomas were compared with each other and with normal chorionic villi and placental site. This involved light microscopic, immunohistochemical and ultrastructural studies. Comparison of PSTT with choriocarcinoma suggested that the former represented a neoplastic transformation of placental site intermediate trophoblast. The PSTT showed a characteristic immunohistochemical distribution of human placental lactogen and human chorionic gonadotropin, resembling that of the placental site intermediate trophoblast. Placental site trophoblastic tumor cells were also characterized ultrastructurally by prominent perinuclear filaments, abundant rough endoplasmic reticulum, or both. Infiltrating intermediate trophoblasts in exaggerated placental sites were similar to PSTT cells rather than normal placental site intermediate trophoblasts. However cells with vacuolated cytoplasm or spindle-shaped intermediate trophoblastic cells were observed more frequently in the PSTT than the exaggerated placental sites. The intermediate trophoblastic cells in the choriocarcinomas showed a morphologically transitional form from cytotrophoblastic cell to syncytiotrophoblastic cell, but did not share unique ultrastructural similarities with placental site intermediate trophoblasts.- - - - - - - - - - ranking = 11keywords = intermediate (Clic here for more details about this article) |
9/13. Malignant trophoblastic tumors: immunohistochemical and flow cytometric comparison of choriocarcinoma and placental site trophoblastic tumors.We performed an immunohistochemical and flow cytometric study of the formalin-fixed, paraffin-embedded tissues of eight recent gestational choriocarcinomas (CCs) and three placental-site trophoblastic tumors (PSTTs). The follow-up period ranged from 1 to 144 months (mean, 74.3 months). In the CCs, which consisted predominantly of cytotrophoblasts and syncytiotrophoblasts intermingled with small amounts of intermediate trophoblasts, cytotrophoblasts were occasionally positive for beta-subunit human chorionic gonadotropin (HCG) and syncytiotrophoblasts contained abundant HCG. Some intermediate trophoblasts were positive for HCG and many were positive for human placental lactogen. In the three PSTTs, which were characterized by a monomorphic proliferation of intermediate trophoblasts, the tumor cells were positive for human placental lactogen and placental alkaline phosphatase. The tumors of two patients, including one fatal case, contained more human placental lactogen-positive cells than HCG-positive cells, while the tumor of the remaining patient, who had high serum HCG levels, showed a reversed staining pattern resembling that of CC; this patient has been alive without disease for 9 years. One CC patient and one PSTT patient died of multiple lung metastases, despite hysterectomy and multiagent chemotherapy. All CCs and PSTTs had an exclusively diploid dna content, and there was no correlation among histopathologic and immunohistochemical features, dna ploidy, S-phase fraction, and clinical outcome for patients with these tumors. These results suggest that there is a PSTT that immunohistochemically resembles CC and that flow cytometric and immunohistochemical analysis may not be effective tools to predict the biologic behavior of malignant trophoblastic tumors.- - - - - - - - - - ranking = 3keywords = intermediate (Clic here for more details about this article) |
10/13. Treatment of placental site trophoblastic tumor with hysterotomy and uterine reconstruction.BACKGROUND: Placental site trophoblastic tumor is an unusual variant of gestational trophoblastic neoplasia that is usually confined to the uterus, although 10% of patients have metastases. Because this tumor occurs in women of reproductive age, preservation of fertility may be relevant. Therefore, local excision of placental site trophoblastic tumor by hysterotomy may have a place in management. CASE: A 25-year-old woman, gravida 1, para 1, presented with irregular bleeding. Uterine curettage revealed intermediate trophoblasts that on immunostaining were positive for hCG and human placental lactogen, consistent with placental site trophoblastic tumor. Endovaginal ultrasonography and magnetic resonance imaging demonstrated tumor localized to the anterior fundal myometrium. The patient underwent local excision of the tumor by hysterotomy followed by uterine reconstruction. Pathologic examination confirmed that the surgical margins were free of tumor. The patient has had no recurrence. Two subsequent pregnancies resulted in two spontaneous abortions. A third pregnancy was carried to term. The patient was delivered by cesarean because of the hysterotomy. The hysterotomy scar was intact at cesarean. CONCLUSION: hysterectomy has been recommended by most authors for treatment for placental site trophoblastic tumor. In some patients with localized placental site trophoblastic tumor who desire preservation of fertility, more conservative surgical therapy may be considered.- - - - - - - - - - ranking = 1keywords = intermediate (Clic here for more details about this article) |
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