A diagnostic challenge: extrauterine placental site trophoblastic tumors

Objectives: Extrauterine placental site trophoblastic tumors (PSTT) are very rare and have diagnostic difficulties. We aimed to investigate distinctive clinical and pathological features of extrauterine PSTT. Methods: A literature search was conducted. Results: In total, 13 cases of extrauterine PSTT were identified. Of 13 cases, 4 cases originated from fallopian tubes, 3 from ovary, 2 from vagina, 2 from cervix, 1 from pelvic wall and 1 case from ectopic pregnancy. The mean age of the patients was 33.2 (25–46) years and the mean human chorionic gonadotropin level was 992.16 mIU/mL. In 11 patients, the previous pregnancy history was known and 5 of 11 (45%) had term deliveries, 6 of 11 (55%) had other pregnancy events (3 ectopic pregnancies, 2 abortions, 1 abortion or ectopic pregnancy). In 10 patients main presenting symptoms were available and of 10 patients, 4 (40%) had acute abdominal pain, 3 (30%) had vaginal bleeding, 2 had amenorrhea and 1 had painless swelling. In 10 of 13 patients’ data about tumor spread were available. While no patient had distant metastasis, 3 patients had local spread. Ki-67 proliferation index was performed in 5 patients and mean Ki-67 index was 59.7% (22.8–80). Conclusion: Extrauterine PSTT occur mostly after ectopic pregnancy or abortion with different presenting symptoms than intrauterine PSTT such as acute abdominal pain or painless lesions. It may have higher human chorionic gonadotropin level and Ki-67 index. It tends to stay localized.

Extrauterine placental site trophoblastic tumor; Ectopic pregnancy; Ki-67

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