Geburtshilfe Frauenheilkd 2000; 60(6): 302-307
DOI: 10.1055/s-2000-9538
Review Article

Georg Thieme Verlag Stuttgart · New York

Malignant Placental Site Trophoblastic Tumor - A Rare Gestational Trophoblastic Malignancy

Maligne plazentare Trophoblast-Tumoren - Ein seltener geburtshilflicher BefundW. Janni, P. Hantschmann, J. Rehbock, G. Kindermann
  • I. Frauenklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität, München
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Dezember 2000 (online)

Zusammenfassung

Plazentare Trophoblast-Tumoren sind ein seltener geburtshilflicher und potenziell maligner Befund. Prognosefaktoren sind unter anderem extrauterine Ausbreitung, Zeit seit Beginn der Schwangerschaft, Alter und (möglicherweise) der Mitoseindex. Aufgrund der niedrigen Chemosensibilität scheint die Resektion des primären Tumors ein Eckpfeiler angemessener Therapie zu sein [1] [2]. Gelingt die vollständige Resektion, so kann eine sehr günstige Prognose erwartet werden. Eine aggressive und multiple Chemotherapie ist erforderlich bei Fernmetastasen oder Resttumoren, allerdings mit infauster Prognose. Postoperative Langzeitbeobachtung ist wegen der langen Rezidivperiode des Trophoblast-Tumors erforderlich.

Schlüsselwörter: Trophoblast-Tumoren als geburtshilfliche Erkrankung - plazentarer Trophoblast-Tumor - multiaggressive multiple Chemotherapie

Abstract

Placental site trophoblastic tumor (PSTT) is a rare type of gestational trophoblastic disease with potential malignant behavior. Prognostic factors include extrauterine spread, time since antecedent pregnancy, age, and (possibly) the mitotic count. Because of low chemosensitivity, resection of the primary tumor is considered to be the cornerstone of adequate therapy [1] [2]. If complete resection of the tumor is achieved, an excellent prognosis can be expected. In cases with distant metastases or residual disease, aggressive multiagent chemotherapy is required. The prognosis in these cases is unfavorable. Because of possibly long latency until the recurrence of PSTT, long-term follow-up is required.

Key words: Gestational trophoblastic disease - placental site trophoblastic tumor - PSTT - multiagent chemotherapy

References

  • 1 Aoki Y, Kodama S, Kurata H, Kase H, Tanaka K. Failure of high-dose chemotherapy with peripheral blood stem cell support for refractory placental site trophoblastic tumor.  Gynecol Obstet Invest. 1999;  47 214-216
  • 2 Bagshawe K D. Risk and prognostic factors in trophoblastic neoplasia.  Cancer. 1976;  38 1373-1385
  • 3 Berkowitz R S, Goldstein D P. Chorionic tumors.  N Engl J Med. 1996;  335 1740-1748
  • 4 Berkowitz R S, Goldstein D P. Recent advances in gestational trophoblastic disease.  Curr Opin Obstet Gynecol. 1998;  10 61-64
  • 5 Bettencourt E, Pinto E, Abraul E, Dinis M, De Oliveira C F. Placental site trophoblastic tumour: the value of transvaginal colour and pulsed Doppler sonography (TV-CDS) in its diagnosis: case report.  Eur J Gynaecol Oncol. 1997;  18 461-464
  • 6 Bradley C S, Benjamin I, Wheeler J E, Rubin S C. Endometrial adenocarcinoma with trophoblastic differentiation.  Gynecol Oncol. 1998;  69 74-77
  • 7 Brandt K R, Coakley K J. MR appearance of placental site trophoblastic tumor: a report of three cases.  Am J Roentgenol. 1998;  170 485-487
  • 8 Chang Y L, Chang T C, Hsueh S, Huang K G, Wang P N, Liu H P, Soong Y K. Prognostic factors and treatment for placental site trophoblastic tumor-report of 3 cases and analysis of 88 cases.  Gynecol Oncol. 1999;  73 216-222
  • 9 Civantos F, Rywlin A M. Carcinomas with trophoblastic differentiation and secretion of chorionic gonadotrophins.  Cancer. 1972;  29 789-798
  • 10 DeBaz B P, Lewis T J. Imaging of gestational trophoblastic disease.  Semin Oncol. 1995;  22 130-141
  • 11 Denny L A, Dehaeck K, Nevin J, Soeters R, van-Wijk A L, Megevand E, Bloch B. Placental site trophoblastic tumor: three case reports and literature review.  Gynecol Oncol. 1995;  59 300-303
  • 12 Dessau R, Rustin G JS, Dent J, Paradinas F J, Bagshawe K D. Surgery and chemotherapy in the management of placental site tumor.  Gynecol Oncol. 1990;  39 56-59
  • 13 Eckstein R P, Russell P, Friedlander M L, Tattersall M H, Bradfield A. Metastasizing placental site trophoblastic tumor: a case study.  Hum Pathol. 1985;  16 632-636
  • 14 Finkler N J, Berkowitz R S, Driscoll S G, Goldstein D P, Bernstein M R. Clinical experience with placental site trophoblastic tumors at the New England Trophoblastic Disease Center.  Obstet Gynecol. 1988;  71 854-857
  • 15 Fukunaga M, Ushigome S. Malignant trophoblastic tumors: immunohistochemical and flow cytometric comparison of choriocarcinoma and placental site trophoblastic tumors.  Hum Pathol. 1993;  24 1098-1106
  • 16 Giacalone P L, Benos P, Donnadio D, Laffaruge F. High-dose chemotherapy with autologous bone marrow transplantation for refractory metastatic gestational trophoblastic disease.  Gynecol Oncol. 1995;  58 383-385
  • 17 Goldstein D P, Zanten P I V, Bernstein M R, Berkowitz R S. Revised FIGO staging system for gestational trophoblastic tumors. Recommendations regarding therapy.  J Reprod Med. 1998;  43 37-43
  • 18 Hammond C B, Borchert L G, Tyrey L, Creasman W T, Parker R T. Treatment of metastatic trophoblastic disease: good and poor prognosis.  Am J Obstet Gynecol. 1973;  115 451-477
  • 19 Heintz A P, Schaberg A, Engelsman E, van-Hall E V. Placental-site trophoblastic tumor: diagnosis, treatment, and biological behavior.  Int J Gynecol Pathol. 1985;  4 75-82
  • 20 Hertig A T. Human trophoblast: normal and abnormal. A plea for the study of the normal so as to understand the abnormal. Ward Burdick Award Address.  Am J Clin Pathol. 1967;  47 249-268
  • 21 Hopkins M, Nunez C, Murphy J R, Wentz W B. Malignant placental site trophoblastic tumor.  Obstet Gynecol. 1985;  66 95 S-100 S
  • 22 Hopkins M P, Drescher C W, McQuillan A, Keyser J, Schmidt R. Malignant placental site trophoblastic tumor associated with placental abruption, fetal distress, and elevated CA-125.  Gynecol Oncol. 1992;  47 267-271
  • 23 Horn L C, Bilek K. Histologic classification and staging of gestational trophoblastic disease.  Gen Diagn Pathol. 1997;  143 87-101
  • 24 How J, Scurry J, Grant P, Sapountzis K, Ostor A, Fortune D, Armes J. Placental site trophoblastic tumor. Report of three cases and review of the literature.  Int J Gynecol Cancer. 1995;  5 241-249
  • 25 Ichikawa N, Zhai Y L, Shiozawa T, Toki T, Noguchi H, Nikaido T, Fujii S. Immunohistochemical analysis of cell cycle regulatory gene products in normal trophoblast and placental site trophoblastic tumor.  Int J Gynecol Pathol. 1998;  17 235-240
  • 26 Jacobs A J, Newlands J R, Green R K. Pure choriocarcinoma of the ovary.  Obstet Gynecol Surv. 1982;  37 603-608
  • 27 Janni W, Hantschmann P, Rehbock J, Braun S, Lochmueller E, Kindermann G. Successful treatment of malignant placental site trophoblastic tumor with combined cytostatic-surgical approach: case report and review of literature.  Gynecol Oncol. 1999;  75 164-169
  • 28 Janni W, Kindermann G. Trophoblasttumoren. Bender HG Klinik der Frauenheilkunde und Geburtshilfe. Urban & Fischer; Munich 1999
  • 29 Kashimura M, Kashimura Y, Oikawa K, Sakamoto C, Matsuura Y, Nakamura S. Placental site trophoblastic tumor: immunohistochemical and nuclear DNA study.  Gynecol Oncol. 1990;  38 262-267
  • 30 Kurman R J, Scully R E, Norris H J. Trophoblastic pseudotumor of the uterus: an exaggerated form of “syncytial endometritis” simulating a malignant tumor.  Cancer. 1976;  38 1214-1226
  • 31 Larsen L G, Theilade K, Skibsted L, Jacobsen G K. Malignant placental site trophoblastic tumor. A case report and a review of the literature.  APMIS. 1991;  Suppl 23 138-145
  • 32 Lathrop J C, Lauchlan S, Nayak R, Ambler M. Clinical characteristics of placental site trophoblastic tumor (PSTT).  Gynecol Oncol. 1988;  31 32-42
  • 33 Lurain J R. Management of high-risk gestational trophoblastic disease.  J Reprod Med. 1998;  43 44-52
  • 34 McLellan R, Buscema J, Currie J L, Woodruff J D. Placental site trophoblastic tumor in a postmenopausal woman.  Am J Clin Pathol. 1991;  95 670-675
  • 35 Muller H J, Obernitz N, Johannes A, Lohrs U. P53 gene product and EGF-receptor are highly expressed in placental site trophoblastic tumor.  Hum Pathol. 1997;  28 1302-1306
  • 36 Newlands E S, Bagshawe K D, Begent R H, Rustin G J, Holden L. Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989.  Br J Obstet Gynaecol. 1991;  98 550-557
  • 37 Newlands E S, Seckl M J, Holden L, Rustin G JS. Results and Toxicity using the EP (Etoposide, cisplatin)/EMA (Etoposide, methotrexate, actinomycin D) schedule in patients with gestational trophoblastic tumours (GTT). International Society for the Study of Trophoblast; Jerusalem 1998
  • 38 Redline R W, Abdul K F. Pathology of gestational trophoblastic disease.  Semin Oncol. 1995;  22 96-108
  • 39 Reid M H, McGahan J P, Oi R. Sonographic evaluation of hydatidiform mole and its look-alikes.  Am J Roentgenol. 1983;  140 307-311
  • 40 Rhoton V A, Wagner J M, Rutgers J L. et al . Placental site trophoblastic tumor: humanplacental lactogen and pregnancy-associated major basic protein as immunohistologic markers.  Hum Pathol. 1998;  29 280-288
  • 41 Samlowski W E, Abbott T M, Kepas D E, Eyre H J. Placenta-site trophoblastic tumor (trophoblastic pseudotumor): case report demonstrating failure of chemotherapy, surgery, and radiotherapy to control metastatic disease.  Gynecol Oncol. 1985;  21 111-117
  • 42 Schink J C, Singh D K, Rademaker A W, Miller D S, Lurain J R. Etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine for the treatment of metastatic, high-risk gestational trophoblastic disease.  Obstet Gynecol. 1992;  80 817-820
  • 43 Scully R E, Young R H. Trophoblastic pseudotumor: a reappraisal (editorial).  Am J Surg Pathol. 1981;  5 75-76
  • 44 Soper J T, Evans A C, Clarke P D, Berchuck A, Rodriguez G, Hammond C B. Alternating weekly chemothrapy with etoposide-methotrexate-dactinomycin/cyclophosphamide-vincristine for high-risk gestational trophoblastic disease.  Obstet Gynecol. 1994;  83 113-117
  • 45 Soper J T, Evans A C, Conaway M R, Clarke P D, Berchuck A, Hammond C B. Evaluation of prognostic factors and staging in gestational trophoblastic tumor.  Obstet Gynecol. 1994;  84 969-973
  • 46 Su Y N, Cheng W F, Chen C A, Lin T Y, Hsieh F J, Cheng S P, Hsieh C Y. Pregnancy with primary tubal placental site trophoblastic tumor - A case report and literature review.  Gynecol Oncol. 1999;  73 322-325
  • 47 Swisher E, Drescher C W. Metastatic placental site trophoblastic tumor: long-term remission in a patient treated with EMA/CO chemotherapy.  Gynecol Oncol. 1998;  68 62-65
  • 48 Swoboda M, Nagl F, Brinninger G, Breitenecker G, Danihel L. Placental site trophoblastic tumour appearing three years after menopause. Placental Site Trophoblastic Tumor. Drei Jahre nach der Menopause.  Geburtsh Frauenheilk. 1997;  46-49
  • 49 Twiggs L B, Okagaki T, Phillips G L, Stroemer J R, Adcock L L. Trophoblastic pseudotumor-evidence of malignant disease potential.  Gynecol Oncol. 1981;  12 238-248
  • 50 Vardar M A, Altintas A. Placental-site trophoblastic tumor. Principles of diagnosis, clinical behaviour and treatment.  Eur J Gynaecol Oncol. 1995;  16 290-295
  • 51 Young R H, Scully R E, McCluskey R T. A distinctive glomerular lesion complicating placental site trophoblastic tumor: report of two cases.  Hum Pathol. 1985;  16 35-42
  • 52 Yuen Y F, Lewis E J, Larson J T, Wilke M S, Rest E B, Zachary C B. Scalp metastases mimicking alopecia areata. First case report of placental site trophoblastic tumor presenting as cutaneous metastasis.  Dermatol Surg. 1998;  24 587-591

Dr. med. Wolfgang Janni

I. Frauenklinik, Klinikum Innenstadt

Maistrasse 11

80337 München