Attempted conservative management of a placental site trophoblastic tumor: a case report.

BACKGROUND: Placental site trophoblastic tumors (PSTTs) are rare malignant forms of gestational trophoblastic neoplasia (GTN). Controversy exists regarding the most important pathologic or radiologic predictors of extent of disease. Consequently, there is limited information as to the best candidates for conservative surgery. CASE: A 28-year-old female presented 18 months after a term delivery with a biopsy confirmed PSTT. She declined hysterectomy. Imaging revealed a locally limited lesion without myometrial invasion, and no evidence of metastatic disease. She was given two cycles of neoadjuvant etoposide, methrotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA/CO) chemotherapy followed by an attempt at laparoscopically guided hysteroscopic resection. Pathology showed extensive myometrial invasion with positive surgical margin, and our recommendation for hysterectomy with pelvic lymph node dissection was accepted. Postoperatively, she was given two cycles ofpaclitaxel, cisplatin alternating with paclitaxel, etoposide (TP/TE) chemotherapy. CONCLUSION: Fertility sparing options are desirable and should be considered. However, as our case and much of the literature demonstrates, hysterectomy remains the most successful treatment.