PLACENTAL SITE TROPHOBLASTIC TUMOR - REPORT OF 3 CASES AND REVIEW OF THE LITERATURE

Three cases of placental site trophoblast tumor (PSTT) are added to 74 cases in the English language literature. One case presented with an anorexic syndrome, the other two with amenorrhea and abnormal vaginal bleeding. The three patients, whose lesions were confined to the uteru s, were treated by total hysterectomy and their follow-up has been une ventful. Review of the literature showed that 62 patients with PSTT we re alive and 15 had died, two as a complication of treatment. The diag nosis of PSTT may be difficult on a dilatation and currettage specimen . Metastases are a powerful indicator of adverse outcome. Prognosis, a s assessed on pathologic criteria, is unreliable; however, a mitotic c ount of more than five mitoses per 10 high power fields is significant . Surgery is the mainstay of treatment. Hysterectomy is generally indi cated, but young patients who wish to remain fertile may be treated by conservative surgery. In a few cases of progressive disease, chemothe rapy has achieved remission, but generally chemotherapy and radiothera py are ineffective. Long-term follow-up is essential as PSTT may progr ess after years of remission. Serum human chorionic gonadotrophin (hCG ) levels are the best available marker of disease, but the disease may still progress even if hCG levels are not raised.