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Placental site trophoblastic tumor — Clinical Guidelines

Overview

Placental site trophoblastic tumor (PTT) is a rare form of gestational trophoblastic disease characterized by intermediate trophoblastic cells arising from the placental implantation site rather than the conceptus itself. It typically presents in the postpartum period but can occur years after delivery 22.

Diagnosis

Clinical Presentation: Often asymptomatic initially, may present with abnormal uterine bleeding, pelvic pain, or a palpable mass 22.

Imaging: Ultrasound and MRI can help identify the mass and assess for local invasion or metastasis 6.

Histopathology: Definitive diagnosis requires histopathological examination showing intermediate trophoblastic cells with syncytiotrophoblastic giant cells 22.

Markers: Elevated serum beta-hCG levels are common but not specific 22.

Management

Surgical Resection: Primary treatment involves complete surgical resection, often requiring hysterectomy 22.

Chemotherapy: Used for advanced or metastatic disease; regimens may include single-agent methotrexate or more intensive combinations like EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) 22.

Monitoring: Regular follow-up with beta-hCG levels to ensure remission 22.

Special Populations

Pregnancy: PTT typically occurs postpartum, but rare cases may complicate ongoing pregnancies; management focuses on tumor control to preserve fertility when possible 22.

Comorbidities: No specific guidance provided in abstracts; management tailored to individual patient comorbidities 22.

Key Recommendations

Definitive diagnosis requires histopathological examination showing intermediate trophoblastic cells with syncytiotrophoblastic giant cells (Evidence: Expert opinion 22).

Primary treatment involves complete surgical resection, often necessitating hysterectomy (Evidence: Expert opinion 22).

For advanced or metastatic disease, consider chemotherapy regimens such as EMA-CO (Evidence: Expert opinion 22).

Regular monitoring with beta-hCG levels is essential post-treatment to ensure remission (Evidence: Expert opinion 22).

Management in pregnant patients focuses on tumor control while considering the impact on ongoing pregnancy (Evidence: Expert opinion 22).

References

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International journal of environmental research and public health 2022. link 5 Chigusa Y, Mogami H, Minamiguchi S, Kido A, Ishida A, Kurata Y et al.. Chronic abruption-oligohydramnios sequence (CAOS) revisited: possible implication of premature rupture of membranes. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2022. link 6 Schiffer V, van Haren A, De Cubber L, Bons J, Coumans A, van Kuijk SM et al.. Ultrasound evaluation of the placenta in healthy and placental syndrome pregnancies: A systematic review. European journal of obstetrics, gynecology, and reproductive biology 2021. link 7 Carlucci S, Stabile G, Sorrentino F, Nappi L, Botta G, Menato G et al.. The singular case of multiple chorangioma syndrome in an IVF pregnancy. Analysis of the case and review of literature. Placenta 2021. link 8 Vygivska LA, Yakovenko OA, Blagoveschenskiy EV, Babadzhanian YM, Rudenko LA, Yakovenko KV. CURRENT STATE OF THE PROBLEM OFABNORMAL INVASION OF THE PLACENTA IN OBSTETRICS. Wiadomosci lekarskie (Warsaw, Poland : 1960) 2020. link 9 Baergen RN. Kurt Benirschke, MD (1924-2018): Pioneer in Perinatal and Placental Pathology. Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society 2019. link 10 He S, Kosatsky T, Smargiassi A, Bilodeau-Bertrand M, Auger N. Heat and pregnancy-related emergencies: Risk of placental abruption during hot weather. Environment international 2018. link 11 Odibo I, Gehlot A, Ounpraseuth ST, Magann EF. Pathologic examination of the placenta and its clinical utility: a survey of obstetrics and gynecology providers. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2016. link 12 Kitayama C, Sasaki M, Ishikawa H, Mogoe T, Ohsumi S, Fukui Y et al.. Structure and functions of the placenta in common minke (Balaenoptera acutorostrata), Bryde's (B. brydei) and sei (B. borealis) whales. The Journal of reproduction and development 2015. link 13 Walsh CA, McAuliffe FM, Turowski G, Roald B, Mooney EE. A survey of obstetricians' views on placental pathology reporting. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2013. link 14 Baergen RN, Thaker HM, Heller DS. Placental release or disposal? Experiences of perinatal pathologists. Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society 2013. link 15 Kim YW, Kim JS, Lee KA, Shim JY, Won HS, Lee PR et al.. Memb-roller: an effective way of making membrane rolls for pathological examination and studies of human placenta. Placenta 2013. link 16 Acharya G, Albrecht C, Benton SJ, Cotechini T, Dechend R, Dilworth MR et al.. IFPA Meeting 2011 workshop report I: Placenta: Predicting future health; roles of lipids in the growth and development of feto-placental unit; placental nutrient sensing; placental research to solve clinical problems--a translational approach. Placenta 2012. link 17 Gordijn SJ, Dahlstrom JE, Khong TY, Ellwood DA. Histopathological examination of the placenta: key issues for pathologists and obstetricians. Pathology 2008. link 18 Kraus FT. Clinical syndromes with variable pathologic features. 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Biological research 1993. link 24 Benirschke K. The placenta in the context of history and modern medical practice. Archives of pathology & laboratory medicine 1991. link 25 Lee KC, Chan JK. Placental site nodule. Histopathology 1990. link 26 Yoong AF. Electrical shock sustained in pregnancy followed by placental abruption. Postgraduate medical journal 1990. link 27 Waheed A, Laidler PM, Wo YY, Van Etten RL. Purification and physicochemical characterization of a human placental acid phosphatase possessing phosphotyrosyl protein phosphatase activity. Biochemistry 1988. link 28 Svanholm H, Thordsen C. Placental teratoma. Acta obstetricia et gynecologica Scandinavica 1987. link 29 Brink AL, Odendaal HJ. Risk factors for abruptio placentae. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1987. link 30 Yamada T, Isemura M, Yamaguchi Y, Munakata H, Hayashi N, Kyogoku M. Immunohistochemical localization of fibronectin in the human placentas at their different stages of maturation. Histochemistry 1987. link 31 Bohn H, Winckler W. Isolation and characterization of a flavin-containing placental protein (PP3). Archives of gynecology 1987. link 32 Arodi J, Auslender R, Atad J, Weill S, Abramovici H. Giant chorioangioma of the placenta. Acta obstetricia et gynecologica Scandinavica 1985. link 33 Bruns ME, Kleeman E, Mills SE, Bruns DE, Herr JC. Immunochemical localization of vitamin D-dependent calcium-binding protein in mouse placenta and yolk sac. The Anatomical record 1985. link 34 Webb PD, Evans PW, Molloy CM, Johnson PM. Biochemical studies of human placental microvillous plasma membrane proteins. American journal of reproductive immunology and microbiology : AJRIM 1985. link 35 Verheijen FW, Palmeri S, Hoogeveen AT, Galjaard H. Human placental neuraminidase. Activation, stabilization and association with beta-galactosidase and its protective protein. 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Placental site trophoblastic tumor