High-intensity focused ultrasound as a bridging vascular-modulating therapy for fertility-sparing management of placental site trophoblastic tumor complicated by uterine arteriovenous fistula: a case report.
HIFU may be a safe option for reducing tumor vascularity in PSTT, potentially aiding in fertility preservation, but further research is needed to establish its effectiveness.
Where it sits
this study against the rest of the hcg (human chorionic gonadotropin) corpusSummary and findings
This case report discusses the use of high-intensity focused ultrasound (HIFU) in a 23-year-old woman with placental site trophoblastic tumor (PSTT) complicated by uterine arteriovenous fistula. HIFU was performed to reduce tumor perfusion and vascular flow, leading to subsequent low-dose chemotherapy resulting in complete biochemical remission. No major complications were reported, and normal menstrual function resumed during follow-up.
Abstract
<h4>Background</h4>Placental site trophoblastic tumor (PSTT) is a rare gestational trophoblastic neoplasm characterized by local invasiveness and marked vascularity. Surgical management may be associated with substantial bleeding risk and loss of fertility, particularly when complicated by uterine arteriovenous fistula (UAVF). High-intensity focused ultrasound (HIFU) may provide a fertility-preserving adjunctive approach in selected cases.<h4>Case presentation</h4>A 23-year-old woman presented with persistently plateaued serum human chorionic gonadotropin levels following hysteroscopic management for suspected incomplete abortion. Imaging revealed a deeply invasive hypervascular uterine lesion with UAVF, raising strong suspicion of gestational trophoblastic neoplasia. Given her strong desire for fertility preservation and high surgical risk, ultrasound-guided HIFU was performed as an initial vascular-modulating intervention. Subsequent expert pathological review confirmed PSTT.<h4>Results</h4>HIFU achieved significant reduction in lesion perfusion and vascular flow, as confirmed by Doppler ultrasound and contrast-enhanced MRI. Although complete tumor ablation was not achieved due to lesion size and deep invasion, subsequent low-dose chemotherapy resulted in complete biochemical remission accompanied by radiologic regression of residual lesions. No major HIFU-related complications were observed, and normal menstrual function resumed during follow-up.<h4>Conclusion</h4>HIFU is a technically feasible and safe fertility-preserving adjunct for vascular modulation in hypervascular PSTT complicated by UAVF. While HIFU alone may not achieve definitive oncologic control in large or deeply invasive lesions, it can serve as a bridging strategy to reduce tumor perfusion and vascularity, facilitating subsequent systemic therapy in carefully selected patients. This approach demonstrates the potential role of HIFU as a bridging vascular-modulating strategy within multimodal fertility-preserving management.
Background
Placental site trophoblastic tumor (PSTT) is a rare neoplasm that poses challenges in management due to its local invasiveness and vascularity. Surgical interventions can lead to significant bleeding and loss of fertility, particularly when complicated by uterine arteriovenous fistula (UAVF). This study explores high-intensity focused ultrasound (HIFU) as a potential fertility-sparing approach in such complex cases.
Methods
This case report describes a 23-year-old woman with persistently plateaued serum human chorionic gonadotropin levels and imaging findings suggestive of PSTT. HIFU was applied as an initial vascular-modulating intervention due to the high surgical risk associated with her condition. The primary outcome was the reduction in lesion perfusion and vascular flow, assessed through Doppler ultrasound and MRI.
Results
HIFU achieved significant reduction in lesion perfusion and vascular flow, as confirmed by Doppler ultrasound and contrast-enhanced MRI. Complete tumor ablation was not achieved due to lesion size and deep invasion, but subsequent low-dose chemotherapy resulted in complete biochemical remission.
Interpretation
The findings suggest that while HIFU may not provide definitive oncologic control for large or deeply invasive lesions, it can effectively reduce vascularity and facilitate subsequent systemic therapy. This case aligns with prior literature indicating the potential of HIFU in fertility-preserving strategies, though the lack of quantitative data and the single-case nature limit broader applicability.
Key findings
- Significant reduction in lesion perfusion and vascular flow confirmed by Doppler ultrasound and contrast-enhanced MRI.
- Complete biochemical remission achieved after subsequent low-dose chemotherapy.
- Normal menstrual function resumed during follow-up.
Limitations
- Single case report limits generalizability.
- No quantitative data on lesion reduction provided.
- Short follow-up duration raises questions about long-term outcomes.