Placental site trophoblastic tumor presenting with scalp metastases

Abstract

Hartenbach EM, Saltzman AK, Zachary CB, Osborne JL, Okagaki T, Twiggs LB. Placental site trophoblastic tumor presenting with scalp metastases. Int J Gynecol Cancer 1996; 6: 333-336.Placental site trophoblastic tumor (PSTT) usually presents with vaginal bleeding or amenorrhea and an enlarged uterus. Metastasis to the skin as the presenting sign, or as a metastatic site, has not been previously reported with PSTT. We report a case of PSTT in which the presenting sign was scalp metastases and the only other disease was a small focus in the uterus. The patient responded to multi-agent chemotherapy and repeated skin resection at the local site. She received 16 alternating cycles of etoposide-methotrexate-actinomycin D and cytoxan-oncovin (EMM CO) and is currently without evidence of disease. Clinicians caring for reproductive age women should remain aware that gestational trophoblastic disease (GTD) may present in an unusual manner.

Keratoacanthoma-like nodules as first manifestation of metastatic epithelioid trophoblastic tumor

“…The most common metastatic sites for GTD are the lungs, liver, and brain. Gestational trophoblastic Dermatology Online Journal || Case Presentation disease with skin metastases has been reported but is exceedingly rare [17,18]. It is reported that ETT can metastasize to the lung as well as to the brain, liver, abdominal cavity, vagina, tonsil, and lymph nodes [6,8].…”

Gestational Trophoblastic Disease with Painful Skin Metastases

“…Previous reports of skin metastases with this condition describe reddish nodules similar to those seen in our patient. 2 This is a case of a rare complication of a rare disease. It highlights some interesting symptom control issues.…”

“…1 Metastases to the skin are extremely rare indeed. 2 Previous reports document only seven cases of gestational trophoblastic disease with skin metastases. 3 I present a case of a young woman with florid skin metastases that were painful and difficult to manage.…”

“…This case illustrates how challenging pain management in terminally ill levo-methadone maintained patients can be. 2 Sufficient pain control is achievable by continuing and adapting the drug used for maintenance, accepting that higher doses might be needed than used otherwise. Patients must be monitored intensely to avoid acute adverse events such as respiratory depression.…”