Successful delivery after fertility-sparing surgery for stage I placental site trophoblastic tumor: a rare case report.

BACKGROUND: Placental site trophoblastic tumor (PSTT) is a rare subtype of gestational trophoblastic neoplasia (GTN) characterized by relative chemoresistance. The primary recommended treatment, especially for non-metastatic disease, is hysterectomy, making fertility-sparing a significant clinical challenge. There are exceedingly few reported cases of successful uterine preservation, highlighting the need for well-documented management strategies for early-stage patients with a strong desire for future fertility. CASE PRESENTATION: We report the case of a 32-year-old woman (gravida 0, para 0) diagnosed with stage I PSTT, who initially presented with post-amenorrheic vaginal bleeding and fluctuating serum beta-human chorionic gonadotropin (β-hCG) levels and was initially misdiagnosed with an ectopic pregnancy. After unsuccessful methotrexate therapy, pelvic magnetic resonance imaging (MRI) accurately identified a focal myometrial lesion, leading to the correct diagnosis. Guided by multidisciplinary assessment and the patient's fertility desire, fertility-sparing management involving precise resection of the myometrial lesion followed by adjuvant actinomycin D/cyclophosphamide and vincristine (EMA/CO) chemotherapy was implemented to minimize recurrence risk. Following rigorous surveillance, the patient successfully conceived, delivered a healthy infant, and remained disease-free with negative β-hCG, ultrasound, and MRI findings at the 42-day postpartum check-up. CONCLUSION: This case highlights the value of pelvic MRI in facilitating the diagnosis of PSTT and suggests that fertility-sparing surgery combined with adjuvant chemotherapy may be a feasible treatment option for carefully selected patients with stage I PSTT who desire future fertility.