Placental site trophoblastic tumor: p53 gene analysis

Background: Placental site trophoblastic tumor (PSTT) is the rarest type of trophoblastic neoplasm. Because of its rarity, the clinical behavior and pathogenesis of PSTT are still unclear.

Case: A 20-year-old woman presented with secondary amenorrhea and irregular vaginal bleeding. Examination of the patient revealed elevated serum hCG and a uterine mass. The specimen obtained by curettage was diagnosed as possible PSTT. The patient was treated with two cycles of EMA/CO, but her uterine mass increased in size. Subsequently, she underwent total abdominal hysterectomy. Microscopic observation revealed a PSTT. To estimate the status of expression of p53 protein and to determine whether p53 gene mutation was present in this PSTT, we carried out immunohistochemical staining for p53 and PCR-SSCP analysis. Immunohistochemical staining for p53 revealed intense nuclear labeling, but no p53 gene mutation was detected in exons 5-8.

Conclusion: Analysis of the p53 gene may aid understanding of the pathogenesis of PSTT.

Placental site trophoblastic tumor; Multiagent chemotherapy; p53

[1] Kurman R. J., Scully R. E., Norris H. J.: "Trophoblastic pseudotumor of the uterus: an exaggerated form of'syncytial endometritis' simulating a malignant tumor'. Cancer, 1976, 38, 1214.

[2] Twiggs L. B., Okagaki T., Phillips G. L., Stroemer J. R., Adcock L. L.: "Trophoblastic pseudotumor-evidence of malignant disease potential". Gynecol. Oncol., 1981, 12, 238.

[3] Scully R. E., Young R. H.: "Trophoblastic pseudotumor: a reappraisal". Am. J. Surg. Pathol., 1981, 5, 75.

[4] Finkler N. J.: "Placental site trophoblastic tumor. Diagnosis, climcal behavior and treatment". J. Reprod. Med., 1991, 36, 27.

[5] Vardar M. A., Altintas A.: "Placental-site trophoblastic tumor. Principles of diagnosis, clinical behaviour and treatment". Eur. J. Gynaecol. Oncol., 1995, 16, 290.

[6] Motoyama T., Ohta T., Ajioka Y., Watanabe H.: "Neoplastic and non-neoplastic intermediate trophoblasts: an immunohistochemical and ultrastructural study". Pathol. Int., 1994, 44, 57.

[7] Kashimura M., Kashimura Y., Oikawa K., Sakamoto C., Matsuura Y., Nakamura S.: "Placental site trophoblastic tumor: immunohistochemical and nuclear DNA study". Gynecol. Oncol., 1990, 38, 262.

[8] Chang Y. L., Chang T. C., Hsueh S., Huang K. G., Wang P. N., Liu H. P., Soong Y. K.: "Prognostic factors and treatment for placental site trophoblastic tumor-report of 3 cases and analysis of 88 cases". Gynecol. Oncol., 1999, 73, 216.

[9] Bagshawe K. D.: "Treatment of high-risk choriocarcinoma". J. Reprod. Med., 1984, 29, 813.

[10] Swisher E., Drescher C. W.: "Metastatic placental site trophoblastic tumor: long-term remission in a patient treated with EMA/CO chemotherapy". Gynecol. Oneal., 1998, 68, 62.

[11] Ianni W., Hantschmann P., Rehbock J., Braun S., Lochmueller E., Kindermann G.: "Successful treatment of malignant placental site trophoblastic tumor with combined cytostatic -surgical approach: case report and review of literature". Gynecol. Oneal., 1999, 75, 164.

[12] Hopkins M. P., Drescher C. W., McQuillan A., Keyser J., Schmidt R.: "Malignant placental site trophoblastic tumor associated with placental abruption, fetal distress, and elevated CA-125". Gynecol. Oneal., 1992, 47, 267.

[13] Muller-Hocker J., Obernitz N., Johannes A., Lohrs U.: "P53 gene product and EGF-receptor are highly expressed in placental site trophoblastic tumor". Hum. Pathol., 1997, 28, 1302.

[14] lchikawa N., Zhai Y. L., Shiozawa T., Toki T., Noguchi H., Nikaido T., Fujii S.: "Immunohistochemical analysis of cell cycle regulatory gene products in normal trophoblast and placental site trophoblastic tumor". Int. J. Gynecol. Pathol., 1998, 17, 235.