Prognostic Factors and Treatment for Placental Site Trophoblastic Tumor—Report of 3 Cases and Analysis of 88 Cases

Chang, Yao‐Lung; Chang, Ting‐Chang; Hsueh, Shun‐Wen; Huang, Kuan-Gen; Wang, Po‐Nan; Liu, Huiping; Soong, Yung Kuei

doi:10.1006/gyno.1999.5344

Cited by 110 publications

(61 citation statements)

References 42 publications

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“…A recent thorough literature review on PSTT can be found elsewhere (Chang et al, 1999) and therefore, only the information regarding the gender of antecedent gestation is reviewed here (Table 1).…”

Section: Literature Reviewmentioning

confidence: 99%

Pathogenesis of Placental Site Trophoblastic Tumor May Require the Presence of a Paternally Derived X Chromosome

Hui

Parkash

Perkins

et al. 2000

Laboratory Investigation

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SUMMARY:Placental site trophoblastic tumor (PSTT) is a neoplastic proliferation of intermediate trophoblasts that invades the myometrium at the placental site after a pregnancy. Less than 100 cases have been reported. Information of the sex assignment of the antecedent gestation is available in 21 cases: 18 of these were female. To explore this interesting phenomenon, we have determined the sex chromosome composition of the tumor tissue preserved in paraffin blocks for five new cases of this condition. The last documented gestational event included a normal vaginal delivery of female infants in three cases, normal vaginal delivery of an infant of unknown sex in one case and a molar gestation in one case. Using the X-linked human androgen receptor (AR) gene as a polymorphic marker, we showed that in all five cases the tumor had a likely XX chromosomal composition; and in four cases it was possible to determine that one of the X chromosomes was of paternal origin. In one case, the paternal X chromosome showed no polymorphism to either maternal X chromosomes. In addition, sensitive semi-nested PCR failed to show a human Y chromosome element in any of the five cases of PSTT. Overall, of 21 cases from the literature and 5 cases of ours, 89% (23 of 26) showed an XX genomic composition in PSTT, either by history or genetic analysis. These results suggest that most PSTT were derived from the antecedent female conceptus and were likely to have possessed a functional paternal X chromosome. Methylation status analysis at the AR locus was performed in the three PSTT in which the paternal X chromosome was identifiable. In two cases, the paternal AR locus was hypomethylated while the corresponding maternal locus was hypermethylated. The methylation status of other loci was not investigated. Collectively, sex chromosome analysis of five cases of PSTT with literature support suggests a unique genetic basis for the development of PSTT that involves the paternal X chromosome. Although largely speculative, an active paternal X chromosome may be of importance in the pathogenesis of PSTT. (Lab Invest 2000, 80:965-972).D uring conception, tissue having paternallyderived genetic material is implanted in the female uterus. Rarely, this event leads to the development of a disease in the mother in the form of gestational trophoblastic disease (GTD). GTD includes some entities characterized by distinct unique genetic modes of pathogenesis which have been recognized for long time (Kajii and Ohama, 1977;Szulman, 1984): in complete hydatidiform moles, more than 90% of the proliferative trophoblasts have a 46, XX diploid pattern, all derived from the sperm (androgenesis). In partial moles, the karyotype is triploid in most cases (eg, 69, XXY), resulting from fertilization of an egg with one or two sperm. In fact, triploid gestations in which there is no duplication of the paternal chromosomes do not have trophoblastic hyperplasia and do not meet the histologic criteria of molar gestation (Jacobs et al, 1982). Therefore, duplication of the pat...

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Section: Literature Reviewmentioning

confidence: 99%

Pathogenesis of Placental Site Trophoblastic Tumor May Require the Presence of a Paternally Derived X Chromosome

Hui

Parkash

Perkins

et al. 2000

Laboratory Investigation

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“…Although, some publications reported a spontaneously regress after curettage, the standard treatment of local PSTT is total abdominal hysterectomy with lymph node dissection. Adnexal micrometastases are rare (3%) and the protection of patients' ovaries is recommended in women particular under 40 years of age [5]. Conservative surgical treatment may have a role in patients with stage I tumors who wish to conserve fertility, as long as their tumors do not have unfavourable prognostic features.…”

Section: Discussionmentioning

confidence: 99%

“…Hysterectomy is the choice of treatment for local disease confined to uterus. Patients with multiple distant metastases need chemotherapy; however, the disease may progress despite treatment with aggressive multi-agent chemotherapy [5].…”

Section: Introductionmentioning

confidence: 99%

A rare cause for gestational trophoblastic neoplasia: Placental site trophoblastic tumor

Ülker¹,

Akyol²,

Gedikbaşı³

et al. 2013

OJOG

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Placental site trophoblastic tumor is a rare sub-group of gestational trophoblastic neoplasia. There is a wide clinical spectrum of presentation and behaviour ranging from a benign condition to an aggressive disease with a fatal outcome. We report a case of placental site trophoblastic tumor in 23-year-old women with irregular vaginal bleeding during postpartum lactation period. In addition to persistent low level B-hCG titers, ultrasound examination revealed a suspicious low-echoic area in the myometrium consistent with gestational trophoblastic disease. After histopathological examination of the specimen achieved by ultrasound-guided dilatation and curettage of the uterus, the placental site trophoblastic tumor diagnosis was made and subsequently total abdominal hysterectomy was performed. The patient had an uneventful recovery, and no recurrence was detected for 40 months in the follow-up period.

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“…Moreover, the tumor cells also displayed nuclear atypia, while chorionic villi and cytotrophoblasts were not evident. In order to confirm the diagnosis, pathologists were asked to perform immunohistochemical (IHC) studies (Table 1 and Figure 2), which indicated that the tumor cells (10)(11)(12). Recurrence occurs in over 30% of cases.…”

Section: Case Presentationmentioning

confidence: 99%

Placental site trophoblastic tumor: A case report and literature review

Zeng

Liu

Tian

et al. 2015

IRDR

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Prognostic Factors and Treatment for Placental Site Trophoblastic Tumor—Report of 3 Cases and Analysis of 88 Cases

Cited by 110 publications

References 42 publications

Pathogenesis of Placental Site Trophoblastic Tumor May Require the Presence of a Paternally Derived X Chromosome

Pathogenesis of Placental Site Trophoblastic Tumor May Require the Presence of a Paternally Derived X Chromosome

A rare cause for gestational trophoblastic neoplasia: Placental site trophoblastic tumor

Placental site trophoblastic tumor: A case report and literature review

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