背景:胎盘部位滋养细胞肿瘤(PSTT)是一种非常罕见的恶性肿瘤,属于怀孕相关疾病的家庭,称为妊娠滋养细胞疾病(GTD)。文献中报道了不到300例PSTT,发生率约为1/50,000-100,000例妊娠,仅占所有GTD的0.23%至3.00%。
方法:我们的报告描述了另外2例PSTT病例,概述了它们的主要诊断特征和后续处理。第一个病例出现在一名37岁女性的持续性葡萄胎中,第2042段;而第二个发生在43岁女性流产5年后,第1031段,先前诊断为乳腺癌,并与胎盘部位结节(PSN)共享一些特征,良性状况.
方法:第一例诊断困难,因为第11周闭经,血清β-人绒毛膜促性腺激素(β-HCG)高,最初的超声图像是囊泡痣。在扩张和刮宫之后,组织学证实了先前的假设。然而,PSTT的最终组织学是在大手术后获得的.相反,第二例病例的诊断没有那么困难,但令人惊讶,由于常规经阴道超声检查在随后的宫腔镜引导活检中显示可疑子宫内膜厚度对PSTT呈阳性。
方法:治疗包括子宫切除术和随后的随访。由于疾病的初始阶段,未进行淋巴结清扫或淋巴结取样。
结果:在第一种情况下,手术后血清β-HCG值很高,而在第二个中,他们总是消极的。此后,两者都经历了定期血清肿瘤标志物的随访,影像学研究和临床评估,在3年零15个月内显示阴性结果,分别。
结论:详细的妇科超声检查对于了解下一步超声引导的D&C或宫腔镜活检以及术前分期评估非常有帮助。相反,确定血清β-HCG曲线是至关重要的,只是在最初的阳性值进行临床评估和随访。如果预后因素良好,主要治疗仍是子宫切除术。
BACKGROUND: Placental site trophoblastic tumor (PSTT) is a very rare malignant tumor, belonging to a family of pregnancy-related illnesses, called gestational trophoblastic diseases (GTD). Less than 300 cases of PSTT have been reported in literature, with an incidence of ≈ 1/50,000-100,000 pregnancies representing only 0.23% to 3.00% of all GTDs.
METHODS: Our report describes 2 additional cases of PSTT outlining their main diagnostic features and the subsequent management. The first
case presented contemporary to a persistent hydatidiform mole in a 37-year-old woman, para 2042; whereas the second one originated 5 years after a miscarriage in 43-year-old woman, para 1031 with a previous diagnosis of breast cancer, and shared some features with placental site nodule (PSN), a benign condition.
METHODS: The first
case had a difficult diagnosis because there was an amenorrhea of 11th week with high serum beta-human chorionic gonadotropin (beta-HCG) and an initial ultrasound image of vesicular mole. After the Dilatation and Curettage, histology confirmed the previous hypothesis. However, the final histology of PSTT was obtained after major surgery. On the contrary, the diagnosis of the second case was less challenging but surprising, thanks to a routine trans-vaginal ultrasound showing a suspicious endometrial thickness positive for PSTT at a subsequent hysteroscopic guided biopsy.
METHODS: The treatment consisted of hysterectomy and subsequent follow up. Lymphadenectomy or lymph node sampling were not performed due to the initial stage of the disease.
RESULTS: In the first
case, there were high values of serum beta-HCG that plummeted after the surgery, whereas in the second one they had been always negative. Hereafter, both went through a follow up with periodic serum oncological markers, imaging studies and clinical evaluation, which have showed negative result for 3 years and 15 months, respectively.
CONCLUSIONS: A detailed gynecological ultrasound examination could be extremely helpful to understand the next diagnostic step of echo-guided D&C or hysteroscopic biopsy and for a pre-operative staging assessment. On the contrary, determining the serum beta-HCG\'s curve is crucial just in
case of an initial positive value to pursue clinical evaluation and follow-up. In
case of good prognostic factors, the main therapy remains hysterectomy.