Placental Site Trophoblastic Tumor

Part of the Current Clinical Pathology book series (CCPATH)


Placental site trophoblastic tumor or PSTT is a bona fide neoplastic proliferation of cells with cytological features of the intermediate trophoblast present at the implantation site. The recognition of the tumor was in late 1970s to early 1980s, although similar lesions had been documented in the literature for over a century ago. The earliest possible description of the lesion was by Marchand in 1895 as “atypical chorioepithelioma” (Monatsschr Geburtshilfe Gynaekol 1:419–38, 1895). Other names of the tumor were used including “atypical choriocarcinoma”, “syncytioma”, a term introduced by Ewing (Am J Obstet Gynecol 56(3):584–6, 1948; Am J Obstet Gynecol 63(4):888–92, 1952; J Philipp Med Assoc 39:720–4, 1963; Surg Gynecol Obstet 10:366–932, 1920), and “chorioepitheliosis” (Gynecol Prat 5(1):31–40, 1954; Z Geburtshilfe Gynakol 147(2):145–203, 1956; Rev Chil Obstet Ginecol 31(4):200–9, 1966). The tumor could be mistaken traditionally as poorly differentiated carcinoma or even sarcoma.


PSTT Diagnostic features Differential diagnosis 


  1. 1.
    Marchand F. Uber die sogenannten “decualen” Geschwulste im Anschloss and normale Geburt, Abort Blasenmole and Extrauterin Schwangerschaft. Monatsschr Geburtshilfe Gynaekol. 1895;1:419–38.Google Scholar
  2. 2.
    Reis RA, Decosta EJ. Syncytioma, syncytial endometritis. Am J Obstet Gynecol. 1948;56(3):584–6.PubMedGoogle Scholar
  3. 3.
    Kistner RW. Malignant syncytioma following benign hydatidiform mole. Am J Obstet Gynecol. 1952;63(4): 888–92.PubMedGoogle Scholar
  4. 4.
    Acosta-Sison H. Is syncytial endometritis (syncytioma) always benign? J Philipp Med Assoc. 1963;39: 720–4.PubMedGoogle Scholar
  5. 5.
    Ewing J. Choriomas: a clinical and pathological study. Surg Gynecol Obstet. 1920;10:366–932.Google Scholar
  6. 6.
    Huber H, Hormann AG. Malignant chorioepithelioma and chorioepitheliosis. Gynecol Prat. 1954;5(1):31–40.PubMedGoogle Scholar
  7. 7.
    Kehrer E. Pathology of trophoblast development; chorioepithelioma malignum and chorioepitheliosis. Z Geburtshilfe Gynakol. 1956;147(2):145–203. concl.PubMedGoogle Scholar
  8. 8.
    Cruz H, Fischer O, Guzman A. Chorioepitheliosis. Rev Chil Obstet Ginecol. 1966;31(4):200–9.PubMedGoogle Scholar
  9. 9.
    Kurman RJ, Scully RE, Norris HJ. Trophoblastic pseudotumor of the uterus: an exaggerated form of “syncytial endometritis” simulating a malignant tumor. Cancer. 1976;38(3):1214–26.PubMedCrossRefGoogle Scholar
  10. 10.
    Gloor E, Hurlimann J. Trophoblastic pseudotumor of the uterus: clinicopathologic report with immunohistochemical and ultrastructural studies. Am J Surg Pathol. 1981;5(1):5–13.PubMedCrossRefGoogle Scholar
  11. 11.
    Blackwell JB, Papadimitriou JM. Trophoblastic pseudotumor of the uterus: case report and ultrastructure. Cancer. 1979;43(5):1734–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Philippe E, Boue J, Boue A. Trophoblastic gestational diseases. Triploid syndrome, perivillous trophoblastic hyperplasia, trophoblastic pseudotumor, trophoblastic microcarcinoma and carcinoma. Ann Anat Pathol (Paris). 1980;25(1):13–38.Google Scholar
  13. 13.
    Wetzel WJ. Trophoblastic pseudotumor: an illustrative case. Diagn Gynecol Obstet. 1980;2(2):147–50.PubMedGoogle Scholar
  14. 14.
    Twiggs LB, Okagaki T, Phillips GL, Stroemer JR, Adcock LL. Trophoblastic pseudotumor-evidence of malignant disease potential. Gynecol Oncol. 1981;12 (2 Pt 1):238–48.PubMedCrossRefGoogle Scholar
  15. 15.
    Baue G, Hennequin JP. Trophoblastic pseudotumor of the uterus. Unusual 2-stage development. J Gynecol Obstet Biol Reprod (Paris). 1983;12(2):177–82.Google Scholar
  16. 16.
    Scully RE, Young RH. Trophoblastic pseudotumor: a reappraisal. Am J Surg Pathol. 1981;5(1):75–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Young RH, Scully RE. Placental-site trophoblastic tumor: current status. Clin Obstet Gynecol. 1984; 27(1):248–58.PubMedCrossRefGoogle Scholar
  18. 18.
    Scully RE, Bonofiglio TA, Kurman RJ, Sliverberg SG, Wilkinson EJ. Histologic typing of female genital tract tumors. 2nd ed. Spinger-Verlag: New York; 1994.CrossRefGoogle Scholar
  19. 19.
    Baergen RN, Rutgers JL, Young RH, Osann K, Scully RE. Placental site trophoblastic tumor: a study of 55 cases and review of the literature emphasizing factors of prognostic significance. Gynecol Oncol. 2006; 100(3):511–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Hassadia A, Gillespie A, Tidy J, Everard RGNJ, Wells M, Coleman R, et al. Placental site trophoblastic tumour: clinical features and management. Gynecol Oncol. 2005;99(3):603–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Papadopoulos AJ, Foskett M, Seckl MJ, McNeish I, Paradinas FJ, Rees H, et al. Twenty-five years’ clinical experience with placental site trophoblastic tumors. J Reprod Med. 2002;47(6):460–4.PubMedGoogle Scholar
  22. 22.
    Chang YL, Chang TC, Hsueh S, Huang KG, Wang PN, Liu HP, et al. Prognostic factors and treatment for placental site trophoblastic tumor-report of 3 cases and analysis of 88 cases. Gynecol Oncol. 1999;73(2): 216–22.PubMedCrossRefGoogle Scholar
  23. 23.
    Nigam S, Singhal N, Kumar Gupta S, Chhabra D, Manaktala U. Placental site trophoblastic tumor in a postmenopausal female–a case report. Gynecol Oncol. 2004;93(2):550–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Feltmate CM, Genest DR, Wise L, Bernstein MR, Goldstein DP, Berkowitz RS. Placental site trophoblastic tumor: a 17-year experience at the New England Trophoblastic Disease Center. Gynecol Oncol. 2001;82(3):415–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Palmieri C, Fisher RA, Sebire NJ, Lindsay I, Smith JR, McCluggage WG, et al. Placental site trophoblastic tumour arising from a partial hydatidiform mole. Lancet. 2005;366(9486):688.PubMedCrossRefGoogle Scholar
  26. 26.
    Eckstein RP, Paradinas FJ, Bagshawe KD. Placental site trophoblastic tumour (trophoblastic pseudotumour): a study of four cases requiring hysterectomy including one fatal case. Histopathology. 1982;6(2): 211–26.PubMedCrossRefGoogle Scholar
  27. 27.
    Lambie AT, Baird DT, Thomson D, MacDonald MK, Robson JS. Nephrotic syndrome in association with a trophoblastic neoplasm. Clin Nephrol. 1982;17(3): 160–1.PubMedGoogle Scholar
  28. 28.
    Young RH, Scully RE, McCluskey RT. A distinctive glomerular lesion complicating placental site trophoblastic tumor: report of two cases. Hum Pathol. 1985;16(1):35–42.PubMedCrossRefGoogle Scholar
  29. 29.
    Bonazzi C, Urso M, Dell’Anna T, Sacco S, Buda A, Cantu MG. Placental site trophoblastic tumor: an overview. J Reprod Med. 2004;49(8):585–8.PubMedGoogle Scholar
  30. 30.
    Piura B, Shaco-Levy R. Placental site trophoblastic tumor. Harefuah. 2007;146(1):62–7. 77.PubMedGoogle Scholar
  31. 31.
    Brewer CA, Adelson MD, Elder RC. Erythrocytosis associated with a placental-site trophoblastic tumor. Obstet Gynecol. 1992;79(5(Pt 2)):846–9.PubMedGoogle Scholar
  32. 32.
    Machtinger R, Gotlieb WH, Korach J, Fridman E, Apter S, Goldenberg M, et al. Placental site trophoblastic tumor: outcome of five cases including fertility preserving management. Gynecol Oncol. 2005;96(1): 56–61.PubMedCrossRefGoogle Scholar
  33. 33.
    Sakamoto C, Oikawa K, Kashimura M, Egashira K. Sonographic appearance of placental site trophoblastic tumor. J Ultrasound Med. 1990;9(9):533–5.PubMedGoogle Scholar
  34. 34.
    Sumi Y, Ozaki Y, Shindoh N, Katayama H. Placental site trophoblastic tumor: imaging findings. Radiat Med. 1999;17(6):427–30.PubMedGoogle Scholar
  35. 35.
    Hui P, Riba A, Pejovic T, Johnson T, Baergen RN, Ward D. Comparative genomic hybridization study of placental site trophoblastic tumour: a report of four cases. Mod Pathol. 2004;17(2):248–51.PubMedCrossRefGoogle Scholar
  36. 36.
    Xue WC, Guan XY, Ngan HY, Shen DH, Khoo US, Cheung AN. Malignant placental site trophoblastic tumor: a cytogenetic study using comparative genomic hybridization and chromosome in situ hybridization. Cancer. 2002;94(8):2288–94.PubMedCrossRefGoogle Scholar
  37. 37.
    Shih IM, Kurman RJ. The pathology of intermediate trophoblastic tumors and tumor-like lesions. Int J Gynecol Pathol. 2001;20(1):31–47.PubMedCrossRefGoogle Scholar
  38. 38.
    Dotto J, Hui P. Lack of genetic association between exaggerated placental site reaction and placental site trophoblastic tumor. Int J Gynecol Pathol. 2008; 27(4):562–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Baergen RN, Rutgers J, Young RH. Extrauterine lesions of intermediate trophoblast. Int J Gynecol Pathol. 2003;22(4):362–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Abdul-Hafeez M, Akhtar M, Ba aqueel HS, Kidess EA. Placental site trophoblastic tumor: report of a case with review of literature. Ann Saudi Med. 1987;7:340–4.Google Scholar
  41. 41.
    Lee Y, Kim KR, McKeon F, Yang A, Boyd TK, Crum CP, et al. A unifying concept of trophoblastic differentiation and malignancy defined by biomarker expression. Hum Pathol. 2007;38(7):1003–13.PubMedCrossRefGoogle Scholar
  42. 42.
    Shih Ie M. Trophogram, an immunohistochemistry-based algorithmic approach, in the differential diagnosis of trophoblastic tumors and tumorlike lesions. Ann Diagn Pathol. 2007;11(3):228–34.PubMedCrossRefGoogle Scholar
  43. 43.
    Ichikawa N, Zhai YL, Shiozawa T, Toki T, Noguchi H, Nikaido T, et al. Immunohistochemical analysis of cell cycle regulatory gene products in normal trophoblast and placental site trophoblastic tumor. Int J Gynecol Pathol. 1998;17(3):235–40.PubMedCrossRefGoogle Scholar
  44. 44.
    Shih IM, Kurman RJ. Ki-67 labeling index in the differential diagnosis of exaggerated placental site, placental site trophoblastic tumor, and choriocarcinoma: a double immunohistochemical staining technique using Ki-67 and Mel-CAM antibodies. Hum Pathol. 1998;29(1):27–33.PubMedCrossRefGoogle Scholar
  45. 45.
    Kalhor N, Ramirez PT, Deavers MT, Malpica A, Silva EG. Immunohistochemical studies of trophoblastic tumors. Am J Surg Pathol. 2009;33(4):633–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Shih IM, Kurman RJ. Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma. Am J Surg Pathol. 1998;22(11):1393–403.PubMedCrossRefGoogle Scholar
  47. 47.
    Shih IM, Kurman RJ. p63 expression is useful in the distinction of epithelioid trophoblastic and placental site trophoblastic tumors by profiling trophoblastic subpopulations. Am J Surg Pathol. 2004;28(9):1177–83.PubMedCrossRefGoogle Scholar
  48. 48.
    Cole LA, Khanlian SA, Muller CY. Blood test for placental site trophoblastic tumor and nontrophoblastic malignancy for evaluating patients with low positive human chorionic gonadotropin results. J Reprod Med. 2008;53(7):457–64.PubMedGoogle Scholar
  49. 49.
    Cole LA, Khanlian SA, Muller CY, Giddings A, Kohorn E, Berkowitz R. Gestational trophoblastic diseases: 3. Human chorionic gonadotropin-free beta-subunit, a reliable marker of placental site trophoblastic tumors. Gynecol Oncol. 2006;102(2):160–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Schmid P, Nagai Y, Agarwal R, Hancock B, Savage PM, Sebire NJ, et al. Prognostic markers and long-term outcome of placental-site trophoblastic tumours: a retrospective observational study. Lancet. 2009;374(9683):48–55.PubMedCrossRefGoogle Scholar
  51. 51.
    Finkler NJ, Berkowitz RS, Driscoll SG, Goldstein DP, Bernstein MR. Clinical experience with placental site trophoblastic tumors at the New England Trophoblastic Disease Center. Obstet Gynecol. 1988;71(6 Pt 1): 854–7.PubMedGoogle Scholar
  52. 52.
    How J, Scurry J, Grant P, Sapountzis K, Ostor A, Fortune D, et al. Placental site trophoblastic tumor. Report of three cases and review of the literature. Int J Gynecol Cancer. 1995;5(4):241–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Bower M, Paradinas FJ, Fisher RA, Nicholson SK, Rustin GJ, Begent RH, et al. Placental site trophoblastic tumor: molecular analysis and clinical experience. Clin Cancer Res. 1996;2(5):897–902.PubMedGoogle Scholar
  54. 54.
    Shih I, Mazur MT, Kurman RJ. Gestational trophoblastic tumors and related tumor-like lesions. In: Kurman R.J., Hedrick-Ellenson L., Ronnett B.M., editor. 6th ed. Springer; 2011.Google Scholar
  55. 55.
    Fukunaga M, Ushigome S. Malignant trophoblastic tumors: immunohistochemical and flow cytometric comparison of choriocarcinoma and placental site trophoblastic tumors. Hum Pathol. 1993;24(10):1098–106.PubMedCrossRefGoogle Scholar
  56. 56.
    Fukunaga M, Ushigome S. Metastasizing placental site trophoblastic tumor. An immunohistochemical and flow cytometric study of two cases. Am J Surg Pathol. 1993;17(10):1003–10.PubMedCrossRefGoogle Scholar
  57. 57.
    Piura B. Placental site trophoblastic tumor–a challenging rare entity. Eur J Gynaecol Oncol. 2006; 27(6):545–51.PubMedGoogle Scholar
  58. 58.
    Cole LA. New discoveries on the biology and detection of human chorionic gonadotropin. Reprod Biol Endocrinol. 2009;7:8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PathologyYale University School of MedicineNew HavenUSA

Personalised recommendations