Case of PSTT treated with chemotherapy followed by open uterine tumor resection to preserve fertility.

BACKGROUND: Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic malignancy, usually seen in young women with a 20% fatality rate. The hysterectomy is general for PSTT, but hysterectomy is undesirable for patients who wish to remain fertile. Recent advancement of chemotherapy and tumor detection and assessment technologies should allow removal of tumor from the uterus by conservative surgery, without losing fertility, although very few cases have been reported to date. This report describes a young PSTT patient treated by combination chemotherapy and open uterine surgery, which resulted in an early restoration of the menstrual cycle and apparent preservation of fertility.

CASE: A 26-year-old secundigravida primipara woman presented with a case of PSTT which was diagnosed 4 months after a spontaneous abortion. The tumor was confined to the uterus. Two courses of EMA/CO chemotherapy resulted in a remarkable reduction of the tumor mass, but low levels of serum beta-hCG persisted. After precise evaluation of the residual tumor by MRI and hysteroscopy, the anterior wall of the uterus was opened to resect the tumor in the posterior myometrium. An argon beam coagulator was used to evaporate the myometrium tissue surrounding the lesion. One week later, the patient had normal menstruation. MRI taken 2 weeks after the operation detected no tumor in the uterus nor uterine deformation. Serum beta-hCG was reduced below the level of detection.

CONCLUSIONS: Open uterine resection of PSTT tumor following appropriate chemotherapy could achieve long-term remission and save fertility of young patients who wish to avoid hysterectomy for future pregnancy.