Placental Site Trophoblastic Tumor: Diagnostic and Therapeutic Advancement and A Case Report_West China Medical Journal

Authors：

XIAO Ping ,  YIN Rutie , TONG Longxia , WANG Danqing , LI Qingli

Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

YIN Rutie, Email: 05shopping@sina.com

Keywords：

胎盘部位滋养细胞肿瘤; 宫颈; 妊娠滋养细胞肿瘤

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目的　通过对1例原发于宫颈的胎盘部位滋养细胞肿瘤（PSTT）的资料及相关文献的复习，全面介绍胎盘部位滋养细胞肿瘤的临床特征、病理特点、治疗方式及预后。方法　对收治1例罕见原发于宫颈部位的PSTT的临床病理资料进行分析，并以“胎盘部位滋养细胞肿瘤”为主题词查阅中国知网（CNKI）及PubMed等文献数据库进行文献复习。结果　该例原发于宫颈部位的PSTT患者术后化学疗法后，目前情况良好，已随访3年，无复发及转移征象。2011年9月1日前，CNKI数据库共报道300余例PSTT病例，PubMed数据库共160余例，其中有2例原发于宫颈部位的PSTT。原发于宫颈部位的PSTT罕见，易误诊，往往需要宫颈活组织检查或宫颈搔刮才能确诊。结论　原发于宫颈部位的PSTT的预后是否遵循PSTT尚需收集更多的病例证实。PSTT因其发病率低，临床表现多无特异性，通常需要通过诊断性刮宫、活组织检查甚至术后病理检查才能确诊。PSTT首选的治疗方式为手术，多数患者病灶清除后可治愈，对有高危因素的患者术后宜选择依托泊苷+甲氨蝶呤+放线菌素D+环磷酰胺+长春新碱（EMA-CO）方案或依托泊苷+甲氨蝶呤+放线菌素D+依托泊苷+顺铂（EMA-EP）方案进行化学治疗，以期改善预后。

Citation： XIAO Ping,YIN Rutie,TONG Longxia,WANG Danqing,LI Qingli. Placental Site Trophoblastic Tumor: Diagnostic and Therapeutic Advancement and A Case Report. West China Medical Journal, 2012, 27(3): 363-367. doi: Copy

1.	Kurman RJ, Scully RE, Norris HJ. Trophoblastic psuedotumor of the uterus. An exaggerated form of “synctial endometritis” simulating a malignant tumor[J]. Cancer, 1976, 38(3): 1214-1226.
2.	Twiggs LB, Okagaki T, Philips GL, et al. Trophoblastic pseudotumor- evidence of malignant disease potential[J]. Gynecol Oncol, 1981, 12(2 Pt 1): 238-248.
3.	Scully RE, Young RH. Trophoblastic pseudotumor: a reappraisal[J]. Am J Surg Pathol, 981, 5(1): 75-76.
4.	Schmid P, Nagai Y, Agarwal R, et al. Prognostic markers and long-term outcome of placental-site trophoblastic tumours: a retrospective observational study[J]. Lancet, 2009, 374(9683): 48-55.
5.	石一复, 李娟清, 郑伟. 360余万次妊娠中妊娠滋养细胞疾病发生情况调查[J]. 中华妇产科杂志, 2005, 40(2): 76-78.
6.	赵峻, 向阳. 胎盘部位滋养细胞肿瘤及其诊治[J]. 实用肿瘤杂志, 2008, 23(1): 5-7.
7.	Zwischenberger BA, Boren T. Placental site trophoblastc tumor presenting as a friable mass[J]. Eur J Gynaecol Oncol, 2010, 31(5): 570-572.
8.	Soma H, Okada T, Yoshinari T, et al. Placental site trophoblastic tumor of the uterine cervix occurring from undetermined antecedent pregnancy[J]. J Obstet Gynaecol Res, 2004, 30(2): 113-116.
9.	Khan S, Dancey G, Lindsay I, et al. Placental site trophoblastic tumour derived from an oocyte donation pregnancy[J]. BJOG, 2006, 113(3): 344-346.
10.	Hui P, Wang HL, Chu P, et al. Absence of Y chromosome in human placental site trophoblastic tumor[J]. Modern Pathol, 2007, 20(10): 1055-1060.
11.	Hui P, Parkash V, Perkins AS, et al. Pathogenesis of placental site trophoblastic tumor may require the presence of a paternally derived X chromosome[J]. Lab Invest, 2000, 80(6): 965-972.
12.	Baergen RN, Rutgers JL, Young RH, et al. Placental site trophoblastic tumor: a study of 55 cases and review of the literature emphasizing factors of prognostic significance[J]. Gynecol Oncol, 2006, 100(3): 511-520.
13.	Feltmate CM, Genest DR, Wise L, et al. Placental site trophoblastic tumor: a 17-year experience at the New England Trophoblastic Disease Center[J]. Gynecol Oncol, 2001, 82(3): 415-419.
14.	Arroyo MR, Podda A, Cao D, et al. Placental site trophoblastic tumor in the ovary of a young child with isosexual precocious puberty[J]. Pediatr Dev Pathol, 2009, 12(1): 73-76.
15.	Suurmeijer AJH, Gietema JA, Hoekstra HJ. Placental Site trophoblastic tumor in a late recurrence of a nonseminomatous germ cell tumor of the testis[J]. Am J Surg Pathol, 2004, 28(6): 830-833.
16.	Hassadia A, Gillespie A, Tidy J, et al. Placental site trophoblastic tumour: clinical features and management[J]. Gynecol Oncol, 2005, 99(3): 603-607.
17.	Ajithkumar TV, Abraham EK, Rejnishkumar R, et al. Placental site trophoblastic tumor[J]. Obstet Gynecol Survey, 2003, 58(7): 484-488.
18.	Behtash N, Zarchi MK. Placental site trophoblastic tumor[J]. J Cancer Res Clin Oncol, 2008, 134(1): 1-6.
19.	Chang YL, Chang TC, Hsueh S, et al. Prognostic factors and treatment for placental site trophoblastic tumor- report of 3 cases and analysis of 88 cases[J]. Gynecol Oncol, 1999, 73(2): 216-222.
20.	Guvendag GES, Guven S, Esinler I, et al. Placental site trophoblastic tumor in a patient with brain and lung metastases[J]. Int J Gynecol Cancer, 2004, 14(3): 558-563.
21.	Cole LA, Khanlian SA, Muller CY, et al. Gestational trophoblastic diseases: 3. Human chorionic gonadotropin-free β-subunit, a reliable marker of placental site trophoblastic tumors[J]. Gynecol Oncol, 2006, 102(2): 160-164.
22.	Sumi Y, Ozaki Y, Shindoh N, et al. Placental site trophoblastic tumor: imaging findings[J]. Radiat Med, 1999, 17(6): 427-430.
23.	沈丹华, 廖晓耘, 刘艳丽, 等. 胎盘部位过度反应及胎盘部位结节的临床病理分析[J]. 中华病理学杂志, 2004, 33(5): 441-444.
24.	赵峻, 向阳, 万希润, 等. 胎盘部位滋养细胞肿瘤的临床病理特征及预后分析[J]. 中华医学杂志, 2006, 86(27): 1922-1924.
25.	Lan C, Li Y, He J, et al. Placental site trophoblastic tumor: lymphatic spread and possible target markers[J]. Gynecol Oncol, 2010, 116(3): 430-437.
26.	Newlands ES, Mulholland PJ, Holden L, et al. Etoposide and cisplatin/etoposide, methotrexate, and actinomycin-D(EMA) chemotherapy for patients with high-risk gestational trophoblastic tumors refractory to EMA/cyclophosphamide and vincristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors[J]. J Clin Oncol, 2000, 18(4): 854-859.
27.	Nagai Y, Wakayama A, Suzuki S, et al. Metastatic placental site trophoblastic tumour successfully treated with hysterectomy and EMA/CO chemotherapy[J]. J Obstet Gynaecol, 2011, 31(1): 99-101.
28.	Randall TC, Coukos G, Wheeler JE, et al. Prolonged Remission of Recurrent, Metastatic Placental Site Trophoblastic Tumor after Chemotherapy[J]. Gynecol Oncol, 2000, 76(1): 115-117.

1. 　Kurman RJ, Scully RE, Norris HJ. Trophoblastic psuedotumor of the uterus. An exaggerated form of “synctial endometritis” simulating a malignant tumor[J]. Cancer, 1976, 38(3): 1214-1226.
2. 　Twiggs LB, Okagaki T, Philips GL, et al. Trophoblastic pseudotumor- evidence of malignant disease potential[J]. Gynecol Oncol, 1981, 12(2 Pt 1): 238-248.
3. 　Scully RE, Young RH. Trophoblastic pseudotumor: a reappraisal[J]. Am J Surg Pathol, 981, 5(1): 75-76.
4. 　Schmid P, Nagai Y, Agarwal R, et al. Prognostic markers and long-term outcome of placental-site trophoblastic tumours: a retrospective observational study[J]. Lancet, 2009, 374(9683): 48-55.
5. 　石一复, 李娟清, 郑伟. 360余万次妊娠中妊娠滋养细胞疾病发生情况调查[J]. 中华妇产科杂志, 2005, 40(2): 76-78.
6. 　赵峻, 向阳. 胎盘部位滋养细胞肿瘤及其诊治[J]. 实用肿瘤杂志, 2008, 23(1): 5-7.
7. 　Zwischenberger BA, Boren T. Placental site trophoblastc tumor presenting as a friable mass[J]. Eur J Gynaecol Oncol, 2010, 31(5): 570-572.
8. 　Soma H, Okada T, Yoshinari T, et al. Placental site trophoblastic tumor of the uterine cervix occurring from undetermined antecedent pregnancy[J]. J Obstet Gynaecol Res, 2004, 30(2): 113-116.
9. 　Khan S, Dancey G, Lindsay I, et al. Placental site trophoblastic tumour derived from an oocyte donation pregnancy[J]. BJOG, 2006, 113(3): 344-346.
10. 　Hui P, Wang HL, Chu P, et al. Absence of Y chromosome in human placental site trophoblastic tumor[J]. Modern Pathol, 2007, 20(10): 1055-1060.
11. 　Hui P, Parkash V, Perkins AS, et al. Pathogenesis of placental site trophoblastic tumor may require the presence of a paternally derived X chromosome[J]. Lab Invest, 2000, 80(6): 965-972.
12. 　Baergen RN, Rutgers JL, Young RH, et al. Placental site trophoblastic tumor: a study of 55 cases and review of the literature emphasizing factors of prognostic significance[J]. Gynecol Oncol, 2006, 100(3): 511-520.
13. 　Feltmate CM, Genest DR, Wise L, et al. Placental site trophoblastic tumor: a 17-year experience at the New England Trophoblastic Disease Center[J]. Gynecol Oncol, 2001, 82(3): 415-419.
14. 　Arroyo MR, Podda A, Cao D, et al. Placental site trophoblastic tumor in the ovary of a young child with isosexual precocious puberty[J]. Pediatr Dev Pathol, 2009, 12(1): 73-76.
15. 　Suurmeijer AJH, Gietema JA, Hoekstra HJ. Placental Site trophoblastic tumor in a late recurrence of a nonseminomatous germ cell tumor of the testis[J]. Am J Surg Pathol, 2004, 28(6): 830-833.
16. 　Hassadia A, Gillespie A, Tidy J, et al. Placental site trophoblastic tumour: clinical features and management[J]. Gynecol Oncol, 2005, 99(3): 603-607.
17. 　Ajithkumar TV, Abraham EK, Rejnishkumar R, et al. Placental site trophoblastic tumor[J]. Obstet Gynecol Survey, 2003, 58(7): 484-488.
18. 　Behtash N, Zarchi MK. Placental site trophoblastic tumor[J]. J Cancer Res Clin Oncol, 2008, 134(1): 1-6.
19. 　Chang YL, Chang TC, Hsueh S, et al. Prognostic factors and treatment for placental site trophoblastic tumor- report of 3 cases and analysis of 88 cases[J]. Gynecol Oncol, 1999, 73(2): 216-222.
20. 　Guvendag GES, Guven S, Esinler I, et al. Placental site trophoblastic tumor in a patient with brain and lung metastases[J]. Int J Gynecol Cancer, 2004, 14(3): 558-563.
21. 　Cole LA, Khanlian SA, Muller CY, et al. Gestational trophoblastic diseases: 3. Human chorionic gonadotropin-free β-subunit, a reliable marker of placental site trophoblastic tumors[J]. Gynecol Oncol, 2006, 102(2): 160-164.
22. 　Sumi Y, Ozaki Y, Shindoh N, et al. Placental site trophoblastic tumor: imaging findings[J]. Radiat Med, 1999, 17(6): 427-430.
23. 　沈丹华, 廖晓耘, 刘艳丽, 等. 胎盘部位过度反应及胎盘部位结节的临床病理分析[J]. 中华病理学杂志, 2004, 33(5): 441-444.
24. 　赵峻, 向阳, 万希润, 等. 胎盘部位滋养细胞肿瘤的临床病理特征及预后分析[J]. 中华医学杂志, 2006, 86(27): 1922-1924.
25. 　Lan C, Li Y, He J, et al. Placental site trophoblastic tumor: lymphatic spread and possible target markers[J]. Gynecol Oncol, 2010, 116(3): 430-437.
26. 　Newlands ES, Mulholland PJ, Holden L, et al. Etoposide and cisplatin/etoposide, methotrexate, and actinomycin-D(EMA) chemotherapy for patients with high-risk gestational trophoblastic tumors refractory to EMA/cyclophosphamide and vincristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors[J]. J Clin Oncol, 2000, 18(4): 854-859.
27. 　Nagai Y, Wakayama A, Suzuki S, et al. Metastatic placental site trophoblastic tumour successfully treated with hysterectomy and EMA/CO chemotherapy[J]. J Obstet Gynaecol, 2011, 31(1): 99-101.
28. 　Randall TC, Coukos G, Wheeler JE, et al. Prolonged Remission of Recurrent, Metastatic Placental Site Trophoblastic Tumor after Chemotherapy[J]. Gynecol Oncol, 2000, 76(1): 115-117.

West China Medical Journal

Placental Site Trophoblastic Tumor: Diagnostic and Therapeutic Advancement and A Case Report

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