Advertisement

Archives of Gynecology and Obstetrics

, Volume 259, Issue 2, pp 97–103 | Cite as

Metastasizing placental site trophoblastic tumor: Immunohistochemical and DNA analysis 2 case reports and a review of the literature

  • S. Remadi
  • B. Lifschitz-Mercer
  • H. Ben-Hur
  • R. Dgani
  • B. Czernobilsky
Case Reports

Abstract

Placental-site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasia. The clinical behaviour of PSTT is usually benign, but sometimes it can be highly malignant with late recurrence and metastasis. We describe two cases of PSTT with pulmonary metastasis in patients aged 35 and 29 years respectively. The mitotic rate was elevated to 9 and 13 mitotic figures per 10 high-power fields respectively. Immunohistochemical staining showed a predominance of human placental lactogen (hPL) positive cells when compared with human chorionic gonadotropin (hCG) reactive cells in one case, and a reverse pattern in the other one. DNA measurement in one case showed an aneuploid tumor with a tetraploid DNA peak. The clinical behaviour of PSTT remains unpredictable, and there are no reliable means of predicting clinical outcome.

Key words

Placental site trophoblastic tumor Metastasis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Eckstein RP, Paradinas FJ, Bagshawe KD (1982) Placental site trophoblastic tumour (trophoblastic pseudotumor): a study of four cases requiring hysterectomy including one fatal case. Histopathology 6:211–226PubMedGoogle Scholar
  2. 2.
    Eckstein RP, Russel P, Friedlander ML, Tattersall MHN, Bradfield A (1985) Metastasizing placental site trophoblastic tumor: a case study. Hum Pathol 16:632–636PubMedGoogle Scholar
  3. 3.
    Ewing J (1910) Chorioma. Surg Gynecol Obstet 10:366–392Google Scholar
  4. 4.
    Finkler NJ, Berkowitz RS, Driscoll SG, Goldstein DP, Bernstein MR (1988). Clinical experience with placental site trophoblastic tumors at the New England trophoblastic disease center. Obstet Gynecol 71:854–857PubMedGoogle Scholar
  5. 5.
    Fukunaga M, Ushigome S (1993) Malignant trophoblastic tumors: immunohistochemical and flow cytometric comparison of choriocarcinoma and placental site trophoblastic tumors. Hum Pathol 24:1098–106PubMedCrossRefGoogle Scholar
  6. 6.
    Gloor E, Hurlimann J (1981) Trophoblastic pseudotumor of the uterus: clinicopathologic report with immunohistochemical and ultrastructural studies. Am J Surg Pathol 5:5–13PubMedGoogle Scholar
  7. 7.
    Gloor E, Dialdas J, Hurlimann J, Ribolzi J, Barrelet L (1983) Placental site trophoblastic tumor (trophoblastic pseudotumor) of the uterus with metastases and fatal outcome Clinical and autopsy outcome of a case. Am J Surg Pathol 7:483–486PubMedGoogle Scholar
  8. 8.
    Hopkins M, Nunez C, Murphy JR, Budd Wentz W (1985) Malignant placental site trophoblastic tumor. Obstet Gynecol 66:95S-100SPubMedGoogle Scholar
  9. 9.
    Kabawat SE, Mostoufi-Zadeh M, Driscoll SG, Bhan AK (1985) Implantation site in normal pregnancy, a study with monoclonal antibody. Am J Pathol 118:76–84PubMedGoogle Scholar
  10. 10.
    King LA, Okagaki T, Twiggs LB (1992) Resolution of pulmonary metastases with chemotherapy in a patient with placental site trophoblastic tumor. Int J Gynecol Cancer 2:328–331PubMedCrossRefGoogle Scholar
  11. 11.
    Kotylo PK, Michael H, Davis TE, Sutton GP, Mark PR, Roth LM (1992) Flow cytometric DNA analysis of placental site trophoblastic tumors. Int J Gynecol Pathol 11:245–252PubMedGoogle Scholar
  12. 12.
    Kurman RJ, Scully RE, Norris HJ (1976) Trophoblastic pseudotumor of the uterus. An exaggerated form of “syncytial endometritis” simulating a malignant tumor. Cancer 38: 1214–1226PubMedCrossRefGoogle Scholar
  13. 13.
    Kurman RJ, Main CS, Chen HC (1984) Intermediate trophoblast: a distinctive form of trophoblast with specific morphological, bochemical and functional features. Placenta 5:349–370PubMedCrossRefGoogle Scholar
  14. 14.
    Kurman RJ, Young RH, Norris MJ, Main CS, Lawrence WD, Scully RE (1984) Immunocytochemical localization of placental lactogen and chorionic gonadotropin in the normal placenta and trophoblastic tumors, with emphasis on intermediate trophoblast and the placental site trophoblastic tumor. Int J Gynecol Pathol 3:101–121PubMedCrossRefGoogle Scholar
  15. 15.
    Kurman RJ (1994) Blaustein’s pathology of the female genital tract. 4th ed. Springer Berlin Heidelberg New York, pp 1074–1078Google Scholar
  16. 16.
    Marchand F (1985) Über die sogenannten «decidualen» Geschwülste im Anschluß an normale Geburt, Abort, Blasenmole und extrauterine Schwangerschaft. Monatsschr Geburtshilfe Gynaekol 1:419–438Google Scholar
  17. 17.
    McLellan R, Buscema J, Currie JL, Woodruff JD (1991) Placental site trophoblastic tumor in a postmenopausal woman. Am J Clin Pathol 95:670–675PubMedGoogle Scholar
  18. 18.
    Park WW (1981) Pathology and classification of trophoblastic tumors. In: Coppleson W (ed) Gynaecologic Oncology Churchill-Livingstone, Edinburgh. pp 745–756Google Scholar
  19. 19.
    Pearse AGE (1968) Histochemistry: theoretical and applied 3rd ed. Little, Brown and Co, Boston. pp 254–265Google Scholar
  20. 20.
    Schopper W, Pliess G (1949) Über Chorioepitheliosis. Ein Beitrag zur Genese, Diagnostik und Bewertung ektopischer chorionepitheliarer Wucherungen. Virch Arch Pathol Anat 317:347–384CrossRefGoogle Scholar
  21. 21.
    Scully RE, Young RH, (1981) Trophoblastic pseudotumor. A Reappraisal. Am J Surg Pathol 5:75–76PubMedCrossRefGoogle Scholar
  22. 22.
    Silverberg S, Kurman RJ (1991) Tumors of the uterine corpus and gestational trophoblastic disease. Armed Forces Institute of Pathology, Washington DCGoogle Scholar
  23. 23.
    Twiggs LB, Okagaki T, Phillips GL, Stroemer JR, Adcock LL (1981) Trophoblastic pseudotumor. Evidence of malignant disease potential. Gynecol Oncol 12:238–248PubMedCrossRefGoogle Scholar
  24. 24.
    Young RH, Scully RE (1984) Placental-site trophoblastic tumor: current status. Clin Obstet Gynecol 27:248–258PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • S. Remadi
    • 1
  • B. Lifschitz-Mercer
    • 2
  • H. Ben-Hur
    • 3
  • R. Dgani
    • 3
  • B. Czernobilsky
    • 3
  1. 1.Institut de Pathologie CliniqueHôpital Cantonal Universitaire de GenèveGenève 4Switzerland
  2. 2.Institute of PathologySourasky Medical CenterTel AvivIsrael
  3. 3.Dept. of Obstetrics and GynecologyKaplan HospitalRehovotIsrael

Personalised recommendations