Placental site trophoblastic tumor (PSTT): a case report to describe medical legal aspects.

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease with unpredictable malignant potential and highly variable clinical course. The etiology, epidemiology and risk factors of PSTT are poorly understood. Patients that present an abnormal uterine bleeding, uterine enlargement, and positive pregnancy test and are often misdiagnosed about an intrauterine pregnancy, a missed abortion, or an ectopic pregnancy. The majority of patients with PSTT are cured by hysterectomy and a large number of cases require aggressive treatment with chemotherapy and/or radiation. It is described a case of post-mortem diagnosis of PSTT in a 21 year old woman at 25 weeks of gestational age. Patient until admission in hospital refereed episodes of hyper-emesis and exaggerated lose weight. Ultrasonography examination showed a normal fetus growth but a placenta with a cystic formation large 52 for 12 mm. After twenty days of hospital admission patient presents an incoercible emesis with severe malnutrition, heavy anaemic state and subsequent a total alteration of the metabolism the patient deceased. The cause of death is to be charged to an acute cardiac failure. At the autopsy, macroscopic examination of the uterus described a thin wall approximately 2,51 centimetres and a microscopical large trophoblastic cells with abundant eosinophilic cytoplasm and nuclear pleomorphism are seen invading the myometrium. The immunoistochemical features of those cells correspond to those of intermediate trophoblast with focal immunoreactivity for hCG and keratin. Placenta had a small diameter of 15 centimetres and a weight of 154 gr. PSTT introduces like a challenge to the clinical management due to its rarity and with its variability of biological development, therefore, strategy of optimal treatment does not concur one. The diagnostic for image of the PSTT does not help in the clinical identification of the tumor. Some studies showed as ultrasonography (US) that the magnetic resonance (MR) is not specific tools for diagnosis of the existence of the PSTT. In this situation, when ultrasonography showed a fetus with a normal growth without anomalies or malformations it does not be considered the interruption of pregnancy. Despite, in the course of hospitalization had not been performed the dosage of the hormones (B-HCG and H.P.L.) on blood and urine and the literature confirm the concept that these hormones is not settling for the diagnosis of PSTT a cause of variability of the biological development and because the production of these hormones can result absent. Missing the diagnosis of a serious and rare pathology such PSTT and being the patient continuation assiduously and constantly, a lot of precipitation of the clinical picture happens nearly unexpectedly and without warning is a frequently conduction. In truth, has not been shown an interruption and in equal way discharge from professional responsibility the sanitary staff that had she in cure.