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Atypical Placental Site Nodule (APSN) and Association With Malignant Gestational Trophoblastic Disease; A Clinicopathologic Study of 21 Cases

Kaur, Baljeet F.R.C.Path.; Short, Dee; Fisher, Rosemary A. Ph.D., F.R.C.Path.; Savage, Philip M. Ph.D., F.R.C.P.; Seckl, Michael J. Ph.D., F.R.C.P.; Sebire, Neil J. F.R.C.Path.

International Journal of Gynecological Pathology: March 2015 - Volume 34 - Issue 2 - p 152–158
doi: 10.1097/PGP.0000000000000128

The WHO Classification of Gestational Trophoblastic Tumors classifies placental site nodule (PSN) as a benign tumor-like trophoblastic neoplasm. Cases of PSN with atypical features were described [atypical placental site nodule (APSN)] and we started registering APSN in our unit in 2005. The aim of this study is to present our initial experience with these lesions. The Trophoblastic Disease Unit database was searched to identify all patients who were either referred with, or on review were diagnosed with, APSN from September 2005 to May 2013. Case notes and the pathology findings for these patients were retrieved and reviewed. A total of 21 cases of APSN were included, 3 of which were associated with gestational trophoblastic neoplasm on follow-up or review. Malignant gestational trophoblastic disease was associated with 3/21 (14%) cases of APSN, either concurrently or developing/manifesting within 16 mo of APSN diagnosis. None of these patients had raised serum hCG levels either at presentation or follow-up. Presence of APSN should indicate a thorough clinical and radiologic investigation and follow-up if diagnosed on curettage specimens. With increased recognition of this entity and corresponding larger series with longer follow-up, more accurate patient counseling will be possible.

*Departments of Histopathology (B.K., N.J.S.)

Cancer Medicine (D.S., R.A.F., P.M.S., M.J.S.), Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus

Imperial College London, London, UK

The tissue bank is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London.

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

The authors declare no conflict of interest.

Address correspondence and reprint requests to Baljeet Kaur, FRCPath, Department of Cellular Pathology, First Floor, G Block (building 541), Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK. E-mail:

©2015International Society of Gynecological Pathologists