# Trophoblastic tumor in perimenopausal women: A case report and literature review

## TL;DR

A rare case of placental site trophoblastic tumor in a perimenopausal woman is reported, emphasizing the need for accurate diagnosis and surgical treatment.

## Contribution

This case report highlights the rarity of PSTT in perimenopausal women and the importance of a multidisciplinary approach for diagnosis and treatment.

## Key findings

- PSTT occurred 12 years post-pregnancy, an atypical timeline for this condition.
- Surgical management was critical due to PSTT's low sensitivity to chemotherapy.
- Early diagnosis and surgery led to sustained remission for two years.

## Abstract

Placental site trophoblastic tumor (PSTT) a rare form of gestational trophoblastic disease, originates from intermediate trophoblastic cells and presents with nonspecific symptoms, complicating diagnosis. PSTT primarily affects women of childbearing age, but occurrences in perimenopausal women are exceptionally rare.

We report a case of a 54-year-old perimenopausal woman presenting with a two-month history of abnormal uterine bleeding. Clinical and imaging evaluations revealed an enlarged uterus and an intracavitary mass. Elevated β-hCG levels prompted suspicion of a trophoblastic tumor. Histopathological examination confirmed PSTT. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy as definitive treatment. Postoperative outcomes were favorable, with normalization of β-hCG levels and no evidence of recurrence during two years of follow-up. Immunohistochemical staining for HPL and cytokeratin further confirmed the diagnosis.

This case highlights the importance of integrating clinical, imaging, and histopathological findings for the accurate diagnosis of PSTT. Unlike other gestational trophoblastic neoplasms, PSTT is characterized by low sensitivity to chemotherapy, making surgical management the cornerstone of treatment. Long-term follow-up is essential to monitor for potential recurrence.

PSTT is a rare and diagnostically challenging condition, particularly in atypical presentations such as in perimenopausal women. Early and accurate diagnosis, followed by surgical intervention, is critical for favorable outcomes. This case emphasizes the need for heightened clinical awareness and a multidisciplinary approach in managing such rare conditions.

•Rare Diagnosis: PSTT is extremely rare in perimenopausal women.•Unusual Onset: Occurred 12 years post-pregnancy, an atypical timeline.•Diagnostic Challenge: Nonspecific symptoms require clinical, imaging, and histopathological correlation.•Surgical Approach: Hysterectomy with salpingo-oophorectomy is key due to poor chemo response.•Positive Outcome: Early diagnosis and surgery led to sustained remission for two years.•Clinical Impact: Highlights the need for multidisciplinary care and long-term follow-up.

Rare Diagnosis: PSTT is extremely rare in perimenopausal women.

Unusual Onset: Occurred 12 years post-pregnancy, an atypical timeline.

Diagnostic Challenge: Nonspecific symptoms require clinical, imaging, and histopathological correlation.

Surgical Approach: Hysterectomy with salpingo-oophorectomy is key due to poor chemo response.

Positive Outcome: Early diagnosis and surgery led to sustained remission for two years.

Clinical Impact: Highlights the need for multidisciplinary care and long-term follow-up.