Piura B, Rabinovich A, Meirovitz M, Shaco-Levy R
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology and Institute of Pathology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
Int J Gynecol Cancer. 2007 Jan-Feb;17(1):258-62. doi: 10.1111/j.1525-1438.2006.00774.x.
Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic disease that originates from the implantation site intermediate trophoblast. We report four patients with PSTT and review pertinent literature. Three patients presented with disease confined to the uterus and one patient with disease extension beyond the uterus. Antecedent pregnancy was full-term pregnancy in three patients and termination of a 21-week pregnancy in one patient. Interval from the antecedent pregnancy was <1 year in three patients and 13 years in one patient. Primary treatment was simple hysterectomy in three patients and radical hysterectomy in one patient. Overall, three patients received chemotherapy; one had EP/EMA as adjuvant chemotherapy, one had EMA/CO for rising levels of serum beta-hCG and one had BEP then VIP for recurrent disease. The three patients with disease confined to the uterus have remained after treatment alive and with no evidence of disease, whereas the one patient with disease extension beyond the uterus died of disease despite surgery and aggressive chemotherapy. It is concluded that disease extension beyond the uterus is the most important adverse prognostic factor. Other adverse prognostic factors are interval from antecedent pregnancy >2 years, age >40 years, and mitotic count >5 mitotic figures/10 high-power fields. Because of the relative insensitivity to chemotherapy, hysterectomy is the mainstay of treatment. EP/EMA seems to be the most effective first-line chemotherapy available to date for metastatic and relapsing PSTT.
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，起源于着床部位的中间滋养细胞。我们报告4例PSTT患者并复习相关文献。3例患者疾病局限于子宫，1例患者疾病超出子宫范围。前次妊娠3例为足月妊娠，1例为21周妊娠终止。前次妊娠至发病间隔3例＜1年，1例为13年。3例患者的初始治疗为单纯子宫切除术，1例为根治性子宫切除术。总体而言，3例患者接受了化疗；1例以EP/EMA作为辅助化疗，1例因血清β-hCG水平升高接受EMA/CO化疗，1例复发患者先接受BEP化疗后接受VIP化疗。3例疾病局限于子宫的患者治疗后存活且无疾病证据，而1例疾病超出子宫范围的患者尽管接受了手术和积极化疗仍死于疾病。结论是疾病超出子宫范围是最重要的不良预后因素。其他不良预后因素包括前次妊娠至发病间隔＞2年、年龄＞40岁以及有丝分裂计数＞5个有丝分裂象/10个高倍视野。由于对化疗相对不敏感，子宫切除术是主要治疗方法。EP/EMA似乎是目前可用于转移性和复发性PSTT的最有效的一线化疗方案。
