Placenta Accreta Mimicking Placental-Site Trophoblastic Tumor

Abstract

Abstract

Background: Placental-site trophoblastic tumor (PSTT), a rarely seen malignant tumor, arises from the intermediate trophoblast at the implantation site. The trophoblast cells can then infiltrate both the myometrium and blood vessels. Consequently, PSTT can be incorrectly diagnosed as a placental attachment abnormality known as placenta accreta or percreta. Case: A 37-year-old patient (gravida 2, para 1) presented with abnormal vaginal bleeding. Her medical history indicated an uncomplicated first pregnancy, the product of in vitro fertilization, and a complicated second pregnancy, the product of another in vitro fertilization, which had been terminated 1 month previously in the 15th gestational week because of membrane rupture. Therefore, dilatation–curettage was performed for the supposed retained products of conception. Three weeks later, the patient presented again for continued vaginal bleeding. A Doppler ultrasonographic examination revealed a heterogeneous solid mass, 5.5 × 6 cm in diameter, with a high-velocity peripheral vascular pattern, in the uterine cavity. Her free ß-human chorionic gonadotropin (ß-hCG) level was 328 international units(IU)/L, and this level persisted for 3 weeks. Results: Hysterectomy was performed with a prediagnosis of PSTT. Histopathologic evaluation of the mass revealed a final diagnosis of placenta accreta. The patient was discharged 54 hours postsurgery with no complications. Conclusions: Placenta accreta can mimic a rare malignant tumor, PSTT, which has the same laboratory and clinical findings. (J GYNECOL SURG 32:356)