Department of Obstetrics and Gynecology, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan.
Int J Clin Oncol. 2009 Oct;14(5):452-6. doi: 10.1007/s10147-008-0860-5. Epub 2009 Oct 25.
Placental site trophoblastic tumor (PSTT) is a rare type of gestational trophoblastic disease. There is a wide clinical spectrum of presentation and behavior ranging from a benign condition to an aggressive disease with a fatal outcome. PSTT limited to the uterus is in a good prognosis group, but PSTT with metastasis is a lethal disease. We document a case of PSTT with multiple metastases and extremely poor prognosis. A 36-year-old woman had abnormal irregular vaginal bleeding 14 months after her third pregnancy and delivery. The mitotic count of the tumor cells was quite high (23/10 high-power fields). It would have been difficult to remove the tumor by surgery because of the tumor size and its invasion, so we suggested chemotherapy. We treated her with EMA/CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) as a first-line regimen. During the sixth cycle of EMA/CO, the disease became drug-resistant and she died 8 months after the first symptom. This was a rare case among documented patients with PSTT with metastasis, with the patient having short-term survival (<1 year). We conclude that a high mitotic count and atypical undifferentiated pathological features are significant poor prognostic factors for survival in PSTT.
胎盘部位滋养细胞肿瘤（PSTT）是一种罕见的妊娠滋养细胞疾病。其临床表现和行为谱广泛，从良性疾病到具有致命结局的侵袭性疾病。局限于子宫的 PSTT 预后良好，但有转移的 PSTT 是一种致命的疾病。我们报告了一例伴有多处转移和极差预后的 PSTT 病例。一名 36 岁女性在第三次妊娠和分娩后 14 个月出现异常不规则阴道出血。肿瘤细胞的有丝分裂计数相当高（23/10 高倍视野）。由于肿瘤大小及其侵袭性，手术切除肿瘤非常困难，因此我们建议化疗。我们用 EMA/CO（依托泊苷、甲氨蝶呤、放线菌素-D、环磷酰胺、长春新碱）作为一线方案对她进行治疗。在 EMA/CO 的第六个周期中，疾病对药物产生耐药性，她在首次症状出现后 8 个月死亡。这是转移性 PSTT 患者中罕见的病例，患者的生存期较短（<1 年）。我们得出结论，高有丝分裂计数和非典型未分化的病理特征是 PSTT 患者生存的显著不良预后因素。
