Gestational Trophoblastic Disease ECHO-Atypical placental site nodule

Video Transcription

Video Summary

The session featured two cases of atypical placental site nodule (APSN), a rare lesion on the spectrum between benign placental site nodules and intermediate trophoblastic tumors such as epithelioid trophoblastic tumor (ETT) and placental site trophoblastic tumor (PSTT). The moderator introduced Dr. Aaron Preiss, who reviewed APSN pathology, highlighting features such as lesion size, increased cellularity, atypia, and Ki-67 proliferation.<br /><br />In the first case, a 40-year-old patient with abnormal postpartum bleeding was diagnosed with APSN on endometrial biopsy, but hysterectomy revealed ETT limited to the uterus. Because she did not desire fertility, she underwent hysterectomy and is now on surveillance. Discussion emphasized the importance of pathology review, imaging, and determining antecedent pregnancy; DNA genotyping was noted as a useful tool when the culprit pregnancy is unclear.<br /><br />The second case involved a 35-year-old patient who strongly desired fertility preservation. MRI showed no mass, and hysteroscopic resection confirmed APSN without definitive ETT. She is being followed conservatively with imaging, exams, and labs until childbearing is complete.<br /><br />Experts discussed the role of immunohistochemistry, hysteroscopy, MRI, and long-term surveillance, and agreed that hysterectomy remains the default recommendation after fertility is complete.

Keywords

atypical placental site nodule

APSN

epithelioid trophoblastic tumor

ETT

placental site trophoblastic tumor

PSTT

hysterectomy

fertility preservation