Metindir Jale, Pak Işin, Ozdilekcan Ciğdem, Eren Evren
Department of Obstetrics and Gynecology, Ankara Oncology Hospital, Mithatpaşa Caddesi No: 48/12 06420, Kizilay/Ankara, Turkey.
Gynecol Oncol. 2005 Feb;96(2):552-5. doi: 10.1016/j.ygyno.2004.10.030.
Placental site trophoblastic tumor (PSTT) is an uncommon variant of gestational trophoblastic diseases. In most cases, disease is confined to the uterus and treated with a simple hysterectomy. However, 30% of these patients will present with metastatic disease. Patients with metastases frequently have progression of disease and die despite aggressive multiagent chemotherapy.
We present a case of 33-year-old female with PSTT and metastases to the hilar lymph nodes of the right lung. Primary surgical treatment consisting of abdominal hysterectomy and unilateral salpingo-oophorectomy was followed by six cycles of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy. After the completion of chemotherapy, betahCG titers stayed within normal range, but a repeated CT scan of chest revealed enlargement of the hilar lymph nodes. The patient underwent right thoracotomy with hilar lymph nodes resection. The resected nodules were pathologically consistent with primary PSTT.
In this case report, we have determined a PSTT with hilar region metastasis other than parenchyma of lung and confirmed the chemoresistant nature of tumor with the guidance of the previous reports.
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变异型。在大多数情况下，疾病局限于子宫，采用单纯子宫切除术治疗。然而，这些患者中有30%会出现转移性疾病。尽管进行了积极的多药化疗，有转移的患者仍常出现疾病进展并死亡。
我们报告一例33岁女性，患有PSTT并转移至右肺门淋巴结。首先进行了包括腹式子宫切除术和单侧输卵管卵巢切除术的原发性手术治疗，随后进行了六个周期的EMA/CO（依托泊苷、甲氨蝶呤、放线菌素D、环磷酰胺和长春新碱）化疗。化疗完成后，β-hCG水平保持在正常范围内，但胸部CT复查显示肺门淋巴结肿大。患者接受了右胸切开术及肺门淋巴结切除术。切除的结节病理检查结果与原发性PSTT一致。
在本病例报告中，我们确定了一例转移至肺门区域而非肺实质的PSTT，并在前人报告的指导下证实了该肿瘤的化疗耐药性。
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