Atypical recurrence of a placental site trophoblastic tumor four years after hysterectomy for benign condition: Case report and review of literature
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Abstract:
•Rare case of PSTT limited to the vagina presenting eight years after last pregnancy and four years after hysterectomy•Differential diagnosis with other vaginal tumors can be challenging but it is critical because behavior and management are different.•Stage-adapted management is proposed and surgery is the mainstay treatment for localized disease.Keywords:
Rare disease
Abstract Placental site trophoblastic tumor (PSTT) is very rare. It is an unusual variant of gestational trophoblastic neoplasia usually confined to the uterus, although 10% of patients have metastases. The clinical behaviour of PSTT varies and despite knowledge of its histology, diagnosis of this rare form of trophoblastic disease and prediction of its biological behaviour remains difficult due to only a few cases reported in literature.
Gestational Trophoblastic Disease
Trophoblastic Tumor
Gestational trophoblastic neoplasia
Trophoblastic neoplasm
Histology
Placenta Diseases
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Summary: Chorionic villi, whose presence in cases of trophoblastic disease is normally used to exclude both a choriocarcinoma and placental site trophoblastic tumor (PSTT), were present in the initial uterine curettage specimen of a trophoblastic tumor. The lesion shared morphologic features of both an exaggerated placental site reaction and a PSTT. There was infiltration of the posterior wall of the uterus by small clusters and isolated cells which had a prominent affinity for vessels and resembled a usual placental bed reaction. There was, however, deep involvement of myometrium with extension to the cervix, and the condition persisted for 5 months after uterine evacuation. Because different treatment is entailed, identification of this lesion as a tumor of nonvillous trophoblast is also of great importance in a region where the more usual forms of trophoblastic disease represent a declining but not infrequent event. When products of gestation are examined, the possibility of a PSTT should be considered and the clinician alerted if there is a suggestion of excessive intermediate trophoblastic activity, regardless of the presence of chorionic villi. While this may result in the unnecessary followup of some cases, it would permit, with the aid of serial β-hCG and HPL levels, the earlier detection of PSTTs.
Trophoblastic Tumor
Trophoblastic neoplasm
Chorionic villi
Curettage
Gestational Trophoblastic Disease
Myometrium
Trophoblast
Placenta Diseases
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Small cell carcinoma (SmCC) of the vagina is a rare and aggressive tumour. It comprises only 1% –2% of all gynaecological malignancies 85% of the patients with SmCC vagina die within a year of diagnosis. Here we report the case of a 65-year-old woman with stage III primary neuroendocrine carcinoma of vagina who was treated with chemoradiotherapy. The patient survived 1 year and 10 months after the initial presentation. SmCC of the vagina is very rare and despite being aggressive, the local disease can be controlled with a chemoradiation regimen.
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Abstract Placental site trophoblastic tumor (PSTT) represents a rare form of gestational trophoblastic disease. It occurs commonly in females with a history of miscarriage, termination of pregnancy, or any other ongoing pathological pregnancy. We report this rare case in a 23-year-old female, who previously had a history of recurrent miscarriages. In this case, we emphasize on clinical and histopathological features for better understanding and awareness of such rare entities.
Gestational Trophoblastic Disease
Rare disease
Trophoblastic Tumor
Trophoblastic neoplasm
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Placental site trophoblastic tumor (PSTT) is the rare variant of gestational trophoblastic diseases (GTD), which differs histologically and immunologically from GTD. Diagnosis of PSTT is often difficult and delayed. In most cases, diagnosis is not possible until the surgery is performed. The most therapeutic choice is hysterectomy and it is usually successful. Here we report two cases of PSTT.
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Trophoblastic neoplasm
Placenta Diseases
Gestational Trophoblastic Disease
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Placental site trophoblastic tumor (PSTT) is a rare form of the gestational trophoblastic disease (GTD). Seventy four cases have been reported in the English literature up to now. Based on all this data, the death rate is 20% in PSTT. There are many unknown aspect of PSTT on the principles of diagnosis and on the management as well. In this paper, all of the literature related to PSTT has been reviewed and according to these data, diagnosis, clinical behavior and therapy of PSTT have been discussed.
Trophoblastic Tumor
Gestational Trophoblastic Disease
Partial Hydatidiform Mole
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Trophoblastic Tumor
Trophoblast
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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 ceils 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 ultra‐structural similarities with placental site intermediate trophoblasts.
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Human placental lactogen
Human chorionic gonadotropin
Trophoblastic Tumor
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To study the clinicopathologic features and differential diagnosis of placental site trophoblastic tumor (PSTT).5 PSTT cases were studied and compared with 10 choriocarcinoma cases and 2 exaggerated placental site (EPS) cases by light and electron microscope examination and immunohistochemical staining.PSTT occurs in reproductive women and often following term deliveries. Amenorrhea and or vaginal bleeding are common presenting symptoms. The serum levels of hCG are often slightly or moderately elevated. Microscopically, PSTT is composed of only one kind of trophoblast cell, displaying extensive invasion of myometrium and vessels without obvious hemorrhage and necrosis. Mitotic figures are not common. Ultrastructure shows that the tumor cells contain prominent paranuclear filaments. Immunohistochemical reaction reveals positive staining for hPL and mostly negative staining for hCG.PSTT is a rare trophoblastic tumor with unique microscopic, ultrastructural and immunohistochemical features which can help to differentiate them from other trophoblastic diseases.
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Vaginal bleeding
Myometrium
Trophoblast
Placenta Diseases
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Placental site trophoblastic tumor (PSTT) is the rarest form of Gestational Trophoblastic Neoplasia (GTN). We present this case of uterine PSTT to illustrate the difficulties in the diagnosis of this tumor and how this led to delay in its appropriate management..
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Gestational trophoblastic neoplasia
Trophoblastic neoplasm
Placenta Diseases
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