Moore-Maxwell Crystal A, Robboy Stanley J
Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
Gynecol Oncol. 2004 Feb;92(2):708-12. doi: 10.1016/j.ygyno.2003.10.048.
Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease. Little is known about its pathogenesis and natural history.
This report describes two cases that arose in patients with documented complete hydatidiform moles and summarizes the antecedent prenatal histories of PSTTs based on a detailed Medline literature analysis.
A 28-year-old, G(2)P(2) female had a live, 12-week gestation fetus and a coexisting molar pregnancy. Her hCG levels dropped promptly from 1.5 million to 23,273 IU/ml after termination, but rose shortly thereafter together with the onset of recurrent vaginal bleeding. Curettage revealed persistent mole. Persistently elevated hCG led to hysterectomy disclosing a fundal PSTT. The second case was that of a 48-year-old, G(2) woman who presented with symptoms of preeclampsia, hyperthyroidism, and elevated hCG. Curettage yielded a complete hydatidiform mole. Although the hCG level decreased for a short period, it soon increased despite treatment with methotrexate. A second curettage revealed a PSTT.
A Medline literature analysis of PSTT, which consists almost entirely of individual cases and several small series, disclosed that PSTT is preceded in 61% of cases by normal term pregnancy, 12% molar pregnancy, 9% spontaneous abortion, 8% therapeutic abortion, and 3% with ectopic pregnancy, stillbirths or preterm delivery. No information is known in 7%. This report describes two additional cases of PSTT preceded by complete molar pregnancy.
PSTT is a well recognized, but uncommon form of gestational trophoblastic disease. Although little is known about its pathogenesis, it is preceded not uncommonly by an abnormal pregnancy, including a molar pregnancy.
胎盘部位滋养细胞肿瘤（PSTT）是妊娠滋养细胞疾病的一种罕见形式。对其发病机制和自然史了解甚少。
本报告描述了两例发生于确诊为完全性葡萄胎患者的病例，并基于详细的医学文献分析总结了PSTT患者的既往产前病史。
一名28岁、孕2产2的女性怀有一个存活的12周妊娠胎儿，同时合并葡萄胎妊娠。终止妊娠后，她的hCG水平迅速从150万降至23,273IU/ml，但此后不久又升高，同时出现反复阴道出血。刮宫显示有持续性葡萄胎。hCG持续升高导致行子宫切除术，术中发现子宫底部有PSTT。第二例是一名48岁、孕2的女性，出现子痫前期、甲状腺功能亢进和hCG升高的症状。刮宫得到一个完全性葡萄胎。尽管hCG水平短期内下降，但尽管用甲氨蝶呤治疗，它很快又升高。再次刮宫发现了PSTT。
对几乎完全由个别病例和几个小系列组成的PSTT的医学文献分析显示，61%的PSTT病例之前有足月正常妊娠，12%有葡萄胎妊娠，9%有自然流产，8%有治疗性流产，3%有异位妊娠、死产或早产。7%的病例情况不明。本报告描述了另外两例之前有完全性葡萄胎妊娠的PSTT病例。
PSTT是一种公认但不常见的妊娠滋养细胞疾病形式。尽管对其发病机制了解甚少，但它常由异常妊娠引起，包括葡萄胎妊娠。
