The Teaching Point

Placental site trophoblastic tumor is a rare, chemoinsensitive, gestational trophoblastic tumor characterized by the lack of significantly elevated β-hCG levels and commonly associated with amenorrhea or irregular bleeding. The diagnosis is not always straightforward, and MR imaging represents a useful tool when the results of other modalities are indeterminate, although a high level of clinical suspicion is still required.






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Placental site trophoblastic tumor: a case report and review of the literature

Free full text article: Placental site trophoblastic tumor:  a case report and review of the literature

Abstract
We present a case of a gravida 1 para 1 woman, who presented with an 11-month history of amenorrhea after cesarean delivery. The patient was taking birth control pills at the time of presentation. She was observed with a slight elevation of serum β-hCG level, an enlarged heterogeneous uterus and hematometra. A biopsy was performed, and the patient was diagnosed with placental site trophoblastic tumor; the patient then underwent surgery. Placental site trophoblastic tumor is the rarest form of gestational trophoblastic disease, derived from intermediate trophoblast cells. It does not have a pathognomonic appearance; therefore, correlation with medical history, as well as results of laboratory tests and pathological analysis is mandatory. It is a relatively chemoresistant tumor, posing considerable therapeutic challenges; patients with localized disease are managed with surgery and those with metastatic disease require additional chemotherapy. Herein, we review the main features of this entity and top differential diagnosis, as the rarity of this tumor is associated with imaging and pathological pitfalls, reinforcing the need for further experience in this field.






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