Placental site trophoblastic tumor: Outcome of five cases including fertility preserving management

Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic disease that has been re-described during the 1970s. The patients' age at presentation, presenting symptoms, description of last pregnancy, treatment, and outcome were analyzed in five patients diagnosed as PSTT in our department from 1973 to 2003. We describe the clinical outcome of 5 patients with PSTT, four of them were diagnosed and treated since 2001. Mean interval from last pregnancy until diagnosis was 5.1 months (range 0-10 months). Vaginal bleeding was the presenting symptom in all the five patients. Instead of standard hysterectomy followed by chemotherapy, when indicated, one patient underwent fertility preserving management using hysteroscopic resection of the tumor followed by chemotherapy. The combination of operative hysteroscopy and chemotherapy in women with localized disease, who want to preserve their fertility, can be a possible treatment option in highly selected patients. Repeated chemotherapy with EMA/EP, even in patients who relapsed after treatment with EMA/EP for PSTT can induce prolonged remission and even cure.