Successful treatment of malignant placental site trophoblastic tumor with combined cytostatic-surgical approach: Case report and review of literature

Objective. Although rare among gestational trophoblastic diseases, the clin ical relevance of malignant placental site trophoblastic tumor (PSTT) deriv es from its potential malignancy associated with early systemic tumor cell dissemination and manifestation of fatal metastases. Because of the low num ber of cases reported so far worldwide, several treatment strategies have b een under consideration, which will be debated following this case report. Method. We present the case of a 33-year-old female with PSTT and metastase s to the vagina and lung. A 9-month delay in accurate diagnosis was caused by a misinterpretation of her symptoms as signs of a spontaneous abortion. Specialized pathological examination finally led to the diagnosis of PSTT. Primary surgical treatment consisting of abdominal hysterectomy and unilate ral salpingo-oophorectomy was followed by multiple resections of recurrent vaginal disease, After the completion of six cycles of EMA/CO (etoposide, m ethotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy , hCG titers stayed within the normal range. The patient is without evidenc e of disease 39 months after primacy diagnosis. Result. This is the third case of documented long-term remission (>1 year) in metastatic PSTT after combined cryostatic-surgical treatment. Conclusion. Since the few previously reported cases with prolonged remissio n have been treated with the described combined cytostatic-surgical approac h consisting of cytoreductive surgery and adjuvant chemotherapy, this appro ach may be recommended for metastatic PSTT. (C) 1999 Academic Press.