Placental site trophoblastic tumor: a report of radiologic, surgical, and pathologic methods of evaluating the extent of disease.

A dramatic vaginal hemorrhage occurred 1 year after a normal vaginal delivery. A curettage showed placental site trophoblastic tumor. Magnetic resonance imaging and color flow Doppler documented a marked increase in uterine vascularity, as well as an abnormal endomyometrial appearance. Surgery included total abdominal hysterectomy and pelvic lymph node dissection. This confirmed the extensive uterine tumor and also showed an extremely small focus of tumor cells in one lymph node. Immunohistochemical staining for human placental lactogen and for cytokeratin confirmed the histologic finding. After surgery, we gave adjuvant chemotherapy with the EMACO regimen. The radiologic, surgical, and pathologic procedures utilized in this case provided a more complete understanding of the extent of her disease. These techniques may be helpful in making therapeutic decisions for other women with this rare disorder.