Placental site trophoblastic tumor and epithelioid trophoblastic tumor: Clinical and pathological features, prognostic variables and treatment strategy

Gadducci, Angiolo; Carinelli, Silvestro; Guerrieri, Maria Elena; Aletti, Giovanni

doi:10.1016/j.ygyno.2019.03.011

Cited by 59 publications

(85 citation statements)

References 52 publications

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“…Generally, there are two treatment strategies based on patient evaluation: simple hysterectomy and systemic therapy (93–95). The consensuses are that patients of FIGO stage I can be cured by simple hysterectomy with or without pelvic lymph node biopsy (48). In a 17-year clinical trial of PSTT, of all the patients underwent surgery, 5 out of 13 patients relapsed and the recurrence rate was up to 50% (96).…”

Section: Treatment and Prognosismentioning

confidence: 99%

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A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors

et al. 2019

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Placental site trophoblastic tumor (PSTT) is a rare type of gestational trophoblastic disease originating from the intermediate trophoblast. Compared with hydatidiform mole, invasive hydatidiform mole and choriocarcinoma, the diagnosis of PSTT is more complicated and lacks specific and sensitive tumor markers. Most PSTT patients demonstrate malignant potential, and the primary treatment of PSTT is hysterectomy. However, metastasis occasionally occurs and even causes death in a small number of PSTT patients. Most PSTT patients are young women hence fertility preservation is an important consideration. The major obstacle for PSTT patient prognosis is chemotherapy resistance. However, the current understanding of the pathogenesis of PSTT and clinical treatment remains elusive. In this review, we summarized the research progress of PSTT in recent years from three aspects: mechanism, clinical presentation, and treatment and prognosis. Well-conducted multi-center studies with sufficient sample sizes are of great importance to better examine the pathological progress and evaluate the prognosis of PSTT patients, so as to develop prevention and early detection programs, as well as novel treatment strategies, and finally improve prognosis for PSTT patients.

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Section: Treatment and Prognosismentioning

confidence: 99%

“…The prognosis of most PSTT cases is desirable; however, metastasis or recurrence does occur. Detailed information regarding prognosis has been summarized in a previous review (48). FIGO staging is the main factor affecting PSTT prognosis (6, 10).…”

Section: Treatment and Prognosismentioning

confidence: 99%

A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors

et al. 2019

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“…Hysterectomy is the cornerstone of treatment when there is histological diagnosis of intermediate trophoblastic tumour, namely placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT) [ 54 , 55 ]. Unlike other types of GTN, hCG levels are usually relatively lower, and these rare tumours response poorly to conventional chemotherapy regimens.…”

Section: Surgery For Malignant Gestational Trophoblastic Neoplasiamentioning

confidence: 99%

“…Therefore, hysterectomy is the recommended treatment for localised disease, with excision of isolated distant metastasis, especially in the lungs to be considered in selected patients. Around two thirds of the patients with PSTT present with disease localised to uterus, with reported long-term survival rates ranging from 90% to 100% with hysterectomy alone [ 54 ]. In a recent largest series including 54 patients with ETT or mixed PSTT/ETT, two thirds of the patients had FIGO stage I disease, of which all patients who underwent surgery only survived, compared to 71% in patients who underwent combination of surgery and chemotherapy [ 56 ].…”

Section: Surgery For Malignant Gestational Trophoblastic Neoplasiamentioning

confidence: 99%

Surgery including fertility-sparing treatment of GTD

Ngu

Ngan

2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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Gestational trophoblastic disease (GTD) consist of a spectrum of diseases, including hydatidiform moles, invasive mole, metastatic mole, choriocarcinoma, placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). GTD are relatively uncommon disease occurring in women of reproductive age, with high cure rates. Primary treatment of hydatidiform moles includes uterine evacuation, followed by close monitoring of serial hCG levels to detect for post-molar gestational trophoblastic neoplasia (GTN). In patients with GTN, the main therapy consists of chemotherapy, although some surgical procedures are important in selected patients in order to achieve cure. Hysterectomy is the mainstay treatment for PSTT or ETT, and may be considered in selected patients for management of hydatidiform mole and malignant GTN especially in chemoresistant disease. Resection of metastatic lesions such as in the lung or brain can be considered in selected patients with isolated chemoresistant tumour. Surgical treatment of GTD will be discussed in this chapter.

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“…Less common sites of metastasis are represented by the liver, brain, spinal cord, ovary, vagina, peritoneum, spleen, and pancreas. 4 The prevalence of brain metastases in gestational trophoblastic neoplasia. ranges from 3.4 % to 8.8 % , 5 6 but the incidence in placental-site trophoblastic tumor was not reported.…”

Section: Dr Xiangmentioning

confidence: 99%

Placental site trophoblastic disease

Valzacchi

Odetto

Chacón

et al. 2019

Int J Gynecol Cancer

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A case study of a 38-year-old woman with a diagnosis of placental site trophoblastic tumor is presented. The patient had a 22-month history of amenorrhea since her last pregnancy, and a dilation and curettage procedure was performed after a 3.1×2.4×2.8 cm endometrial echogenic lesion was visualized on a pelvic ultrasound. When the diagnosis of placental site trophoblastic tumor was made by histopathologic and immunohistochemical analysis, complementary examinations including including pelvic magnetic resonance imaging (MRI) and a chest computed tomography (CT) were done. There was no evidence of disease outside the uterus, and a laparoscopic hysterectomy with bilateral salpingectomy was performed. After a surveillance period of 12 months, no disease recurrence was identified. Best imaging studies, treatment options, and proper surveillance for these type of tumors are discussed alongside the case study.

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Placental site trophoblastic tumor and epithelioid trophoblastic tumor: Clinical and pathological features, prognostic variables and treatment strategy

Cited by 59 publications

References 52 publications

A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors

A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors

Surgery including fertility-sparing treatment of GTD

Placental site trophoblastic disease

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