Fellow.
Professor, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Obstet Gynecol Surv. 2022 Feb;77(2):101-110. doi: 10.1097/OGX.0000000000000978.
Placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT) are rare forms of gestational trophoblastic neoplasia (GTN). These tumors differ from choriocarcinoma as they are monophasic, have slower growth rates, have lower β-hCG concentrations, and are more chemoresistant. Placental site trophoblastic tumor and ETT can be misdiagnosed, leading to inappropriate management..
The aim of this study was to review the pathogenesis, presentation, pathologic findings, and treatment for PSTT and ETT.
A comprehensive literature review was performed identifying relevant research and review articles. Relevant textbook chapters and guidelines were also reviewed.
Placental site trophoblastic tumor and ETT can present months to years after any antecedent pregnancy event with abnormal uterine bleeding and an elevated β-hCG. Tumors are typically confined to the uterus and secrete lower levels of β-hCG compared with other GTNs. The International Federation of Gynecology and Obstetrics prognostic scoring system does not correlate well with prognosis. These lesions can be misdiagnosed as smooth muscle tumors, metastatic melanoma, and cervical squamous cell carcinoma. However, they can be distinguished by their unique histologic and immunophenotypic features.
Surgery is the mainstay of treatment for early-stage PSTT and ETT. For patients with advanced disease or for those with poor prognostic indicators, such as an antecedent pregnancy interval of greater than 48 months, a multimodal treatment paradigm of surgery and chemotherapy using a high-risk GTN platinum-etoposide containing regimen is recommended.
Placental site trophoblastic tumor and ETT should be considered in the differential diagnosis in a reproductive age patient presenting with abnormal uterine bleeding and an elevated β-hCG after any antecedent pregnancy event.
胎盘部位滋养细胞肿瘤（PSTT）和上皮样滋养细胞肿瘤（ETT）是妊娠滋养细胞肿瘤（GTN）的罕见形式。这些肿瘤与绒毛膜癌不同，因为它们是单相的，生长速度较慢，β-hCG 浓度较低，且对化疗的耐药性更强。胎盘部位滋养细胞肿瘤和上皮样滋养细胞肿瘤可能会被误诊，导致治疗不当。
本研究旨在回顾 PSTT 和 ETT 的发病机制、表现、病理发现和治疗。
进行了全面的文献回顾，确定了相关的研究和综述文章。还回顾了相关的教科书章节和指南。
PSTT 和 ETT 可在任何先前妊娠事件后数月至数年后出现异常子宫出血和β-hCG 升高。肿瘤通常局限于子宫，与其他 GTN 相比，β-hCG 水平较低。国际妇产科联合会（FIGO）预后评分系统与预后相关性不佳。这些病变可能被误诊为平滑肌肿瘤、转移性黑色素瘤和宫颈鳞状细胞癌。然而，它们可以通过其独特的组织学和免疫表型特征来区分。
手术是早期 PSTT 和 ETT 的主要治疗方法。对于晚期疾病或预后不良的患者，例如先前妊娠间隔大于 48 个月，建议采用手术和化疗的多模态治疗方案，化疗采用高危 GTN 含铂依托泊苷方案。
在任何先前妊娠事件后出现异常子宫出血和β-hCG 升高的生殖年龄患者中，应考虑胎盘部位滋养细胞肿瘤和上皮样滋养细胞肿瘤作为鉴别诊断。
