Placental site trophoblastic tumour (PSTT) is a rare and one of the least common (~ 0.2% 7) forms of gestational trophoblastic disease (GTD).
PSTT typically occurs in women of reproductive age with the average age around 30. It may occur after a normal pregnancy, molar pregnancy or even after a terminated pregnancy. Time to presentation can widely vary between 1 week and 14 years.
Presenting symptoms can include either abnormal vaginal bleeding and amenorrhoea 6. Upto 30% of patient may present with metastases at the time of diagnosis 10.
PSTT is composed of neoplastic transformation of intermediate trophoblastic cells that form a polypoid mass that may be within the endometrial canal or the myometrium.
It may be divided into two main types dependant on vascularity 4:
- relatively hypovascular
- in contrast to other forms of gestational trophoblastic disease PSTT produces small amounts of ß-human chorionic gonadotropin; this is thought to be due relative lack of syncytiotrophoblastic tissue within the tumour
- human placental lactogen (hPL) may be increased
There can be some imaging overlap with an invasive mole and choriocarcinoma. One of the key roles of imaging is to attempt to clarify the vascularity of the tumour.
- content needed
Placental site trophoblastic tumour may present as a heterogenous endometrial + myometrial mass although appearances on MRI can be non specific. The junctional zone is disrupted. In the majority of the cases there are cystic spaces and vascular structures.
Reported signal characteristics include 1,3:
- T1: typically isointense compared with healthy myometrium
- T2: isointense to slightly hyperintense compared with myometrium
Treatment and prognosis
A hysterectomy is the primary mode of treatment in the majority of cases 7. The tumour tends to remain confined to the uterus until late in its course although can eventually metastasise to lung, liver, lymph nodes, and brain. Metastases can occur many years after the initial diagnosis 3.
Their biological behaviour is variable, ranging from benign lesions confined to the uterus, to highly aggressive malignant disease with systemic metastases. The main negative prognostic variables are time to presentation from last known pregnancy and mitotic index.
While there can be a good prognosis with localized disease, the tumours tend to be less sensitive to chemotherapy than other forms of gestational trophoblastic disease 6. Chemotherapy may however may still play a role with lesions that are not amenable for curative surgery 7.
History and etymology
First described by R J Kurman et.al in 1976 as a "trophoblastic pseudo-tumour" . The term PSTT was later coined by R E Scully and R H Young in 1981 5.
For MRI appearances consider
- 1. Jung SE, Byun JY, Lee JM et-al. MR imaging of maternal diseases in pregnancy. AJR Am J Roentgenol. 2001;177 (6): 1293-300. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Noonan JB, Coakley FV, Qayyum A et-al. MR imaging of retained products of conception. AJR Am J Roentgenol. 2003;181 (2): 435-9. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Brandt KR, Coakley KJ. MR appearance of placental site trophoblastic tumor: a report of three cases. AJR Am J Roentgenol. 1998;170 (2): 485-7. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Sumi Y, Ozaki Y, Shindoh N et-al. Placental site trophoblastic tumor: imaging findings. Radiat Med. 17 (6): 427-30. - Pubmed citation
- 5. Scully RE, Young RH. Trophoblastic pseudotumor: a reappraisal. Am. J. Surg. Pathol. 1981;5 (1): 75-6. - Pubmed citation
- 6. Kim SJ. Placental site trophoblastic tumour. Best Pract Res Clin Obstet Gynaecol. 2003;17 (6): 969-84. Best Pract Res Clin Obstet Gynaecol (link) - Pubmed citation
- 7. Hassadia A, Gillespie A, Tidy J et-al. Placental site trophoblastic tumour: clinical features and management. Gynecol. Oncol. 2005;99 (3): 603-7. doi:10.1016/j.ygyno.2005.06.054 - Pubmed citation
- 8. Vitellas KM, Bennett WF, Bova JG. Case 2. Placental site trophoblastic tumor. AJR Am J Roentgenol. 2000;175 (3): 896. - Pubmed citation
- 9. Allen SD, Lim AK, Seckl MJ et-al. Radiology of gestational trophoblastic neoplasia. Clin Radiol. 2006;61 (4): 301-13. doi:10.1016/j.crad.2005.12.003 - Pubmed citation
- 10 .Eurorad teaching files : Case 8427