Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess

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The patient presented initially with abdominal pain with, fever, bleeding and pelvic mass on ultrasonography leading to the wrong diagnosis of a pelvic abscess. Dilation and curettage were performed and pathological examination confirmed the diagnosis of placental site trophoblastic tumor. Therefore, she underwent abdominal hysterectomy. Four years after surgery, the patient is still disease free. Gestational trophoblastic diseases should be considered in every patient presenting abnormal uterine bleeding after delivery or pregnancy loss despite the associated symptoms being very unusual." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/11-129/v3", "name": "Case Report: Placental site trophoblastic tumor revealed by a clinical..." } } ] } Home Browse Case Report: Placental site trophoblastic tumor revealed by a clinical... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Nesrine S, Bettaieb H, Mbarki W et al. Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.12688/f1000research.75075.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Revised Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] Souayeh Nesrine https://orcid.org/0000-0001-7049-8076 1 , Hajer Bettaieb 1 , Wael Mbarki 1 , [...] Ben Brahim Ehsen 2 , Helal Imen 2 , Ben Nasr Mehdi 1 , Oueslati Hedhili 1 , Hsayaoui Najeh 1 , Chaouki Mbarki https://orcid.org/0000-0001-7274-3733 1 Souayeh Nesrine https://orcid.org/0000-0001-7049-8076 1 , Hajer Bettaieb 1 , [...] Wael Mbarki 1 , Ben Brahim Ehsen 2 , Helal Imen 2 , Ben Nasr Mehdi 1 , Oueslati Hedhili 1 , Hsayaoui Najeh 1 , Chaouki Mbarki https://orcid.org/0000-0001-7274-3733 1 PUBLISHED 21 Oct 2024 Author details Author details 1 Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia 2 Department of Pathology, Habib Thameur Hospital, Faculty of Medicine of Tunis, Hbib Thameur Hospital, El Manar, Tunisia Souayeh Nesrine Roles: Conceptualization, Writing – Original Draft Preparation Hajer Bettaieb Roles: Data Curation, Methodology, Resources Wael Mbarki Roles: Resources, Software Ben Brahim Ehsen Roles: Investigation, Methodology Helal Imen Roles: Investigation, Methodology Ben Nasr Mehdi Roles: Writing – Review & Editing Oueslati Hedhili Roles: Validation Hsayaoui Najeh Roles: Formal Analysis, Project Administration, Supervision Chaouki Mbarki Roles: Supervision, Validation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Oncology gateway. Abstract We report an uncommon clinical presentation of a placental site trophoblastic tumor. The patient presented initially with abdominal pain with, fever, bleeding and pelvic mass on ultrasonography leading to the wrong diagnosis of a pelvic abscess. Dilation and curettage were performed and pathological examination confirmed the diagnosis of placental site trophoblastic tumor. Therefore, she underwent abdominal hysterectomy. Four years after surgery, the patient is still disease free. Gestational trophoblastic diseases should be considered in every patient presenting abnormal uterine bleeding after delivery or pregnancy loss despite the associated symptoms being very unusual. READ ALL READ LESS Keywords Gestational Trophoblastic Disease, Placenta Diseases, Trophoblastic Tumor, Placental Site, pathology. Corresponding Author(s) Chaouki Mbarki ( [email protected] ) Close Corresponding author: Chaouki Mbarki Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Nesrine S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Nesrine S, Bettaieb H, Mbarki W et al. Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.12688/f1000research.75075.3 ) First published: 01 Feb 2022, 11 :129 ( https://doi.org/10.12688/f1000research.75075.1 ) Latest published: 21 Oct 2024, 11 :129 ( https://doi.org/10.12688/f1000research.75075.3 ) Revised Amendments from Version 2 This new version includes some amendments to the discussion section based on the reviewers' suggestions. In particular, we have made changes to the parts related to differential diagnosis and prognosis, which we believe enhance the overall understanding of the study. These revisions aim to provide readers with a more comprehensive perspective on the findings and their implications in the broader context of PSTT. We trust these updates will contribute to a clearer and more insightful reading experience. This new version includes some amendments to the discussion section based on the reviewers' suggestions. In particular, we have made changes to the parts related to differential diagnosis and prognosis, which we believe enhance the overall understanding of the study. These revisions aim to provide readers with a more comprehensive perspective on the findings and their implications in the broader context of PSTT. We trust these updates will contribute to a clearer and more insightful reading experience. See the authors' detailed response to the review by Seetu Palo See the authors' detailed response to the review by Guglielmo Stabile See the authors' detailed response to the review by Antonio Braga READ REVIEWER RESPONSES Introduction Placental site trophoblastic tumor (PSTT) is a rare tumor, representing 1% of gestational trophoblastic diseases. 1 , 2 It mainly affects women of childbearing age after delivery or pregnancy loss. 1 – 3 In this paper, we report a case of placental site trophoblastic tumor diagnosed by an array of pelvic abscess associated with bleeding occurring two months after delivery. The evolution, after surgical treatment by hysterectomy, was favorable. Case report We report the case of an unemployed 32-year-old Arabic woman, gravida 1 and para 1, without medical history, gave birth naturally and without complications to a full-term healthy newborn. Two months after her delivery, she consulted our department with persisting metrorrhagia associated with fever of 39°C. The patient’s examination revealed that the bleeding has been noted since the delivery day and it had increased two days earlier. A physical examination revealed a fever of 39.5°C and abdominal tenderness. The blood pressure was 110/70 mm Hg and the heart rate was 82 beats/mn. Furthermore, there was no specific digestive or urinary symptom. Per speculum examination, the cervix was enlarged with purulent vaginal discharge. On digital pelvic examination, the uterus was increased in size accessed at 12 week gestation and its mobilization was painful. Blood tests showed an inflammatory syndrome with a C-reactive protein at 200 mg/l [≤ 6mg/l] and white blood cells at 17000/mm 3 [4000-10000/mm 3 ]. The beta-human chorionic gonadotropin (β-HCG) rate was positive at 674 U/l [< 5U/l]. The transvaginal sonography showed a large sized uterus containing an echogenic heterogeneous endometrial mass, vascularized on Doppler examination. This mass seemed to partially invade the myometrium, which suggests hyper vascularized trophoblastic retention. In addition, ultrasound showed an average effusion in the Douglas' pouch ( Figure 1 ) with a left adnexal echogenic mass, suggesting in this context a post-partum pelvic abscess. Figure 1. Sonographic appearance of the tumor of the placental site tumor. (A) Echogenic tumor occupying the uterine cavity (arrow) with infiltration of the myometrium; (B) appearance vascularized tumor at color Doppler. Laparoscopic adnexal drainage and endometrial curettage were performed. The infectious episode resolved promptly with antibiotics; gentamicin 160 mg per day for 5 days metronidazole 500 mg three times a day for 15 days and cefotaxim 1g three times a day for 15 days. Pathological examination of the endometrial curettage specimen reported a proliferation of large tumor cell with eosinophilic cytoplasm and nuclear atypia, infiltrating the myometrium. These cells were positive for pro inflammatory cytokine (IL6) in the immunohistochemistry studies and the final diagnosis was a placental site trophoblastic tumor. A thoracoabdominopelvic CT scan was performed, and it did not reveal any secondary locations. A laparotomic hysterectomy with preservation of ovaries was performed. On gross examination there was a mass of 6 cm localized to the myometrium of bluish appearance with areas of hemorrhage and necrosis. The tumors had ill-defined borders and invaded into the myometrium ( Figure 2 ). Pathological examination was similar to that described in the curettage specimen, showing a proliferation of monomorphic intermediate trophoblasts ( Figure 3A ). The tumor cells demonstrated nuclear atypia, eosinophilic cytoplasm ( Figure 3D ) and myometrial invasion ( Figure 3B , C ). Extensive necrosis, hemorrhage and vascular invasion are observed ( Figure 3E ). We carefully considered and excluded exaggerated placental site response (EPSR), epithelioid trophoblastic tumor (ETT), and gestational choriocarcinoma (GCC) based on specific pathological features observed in this case. EPSR is a benign condition characterized by a lack of nuclear atypia and invasive behavior, features that were not present in this case. Instead, the tumor demonstrated nuclear atypia, eosinophilic cytoplasm, and myometrial invasion, as seen in Figure 3B-D , which are consistent with placental site trophoblastic tumor (PSTT) rather than EPSR. Furthermore, the extensive necrosis, hemorrhage, and vascular invasion observed in the specimen ( Figure 3E ) are not typical of EPSR. ETT was excluded based on the tumor's cellular morphology and growth pattern. ETT typically exhibits more epithelioid cells with less eosinophilic cytoplasm and a nested growth pattern, which contrasts with the monomorphic intermediate trophoblasts and diffuse growth pattern seen in our case. Immunohistochemical staining could further support this distinction, but the morphological differences were sufficiently clear. GCC was ruled out due to the lack of a biphasic population of trophoblasts, which is characteristic of choriocarcinoma. GCC typically shows a mixture of cytotrophoblasts, syncytiotrophoblasts, and intermediate trophoblasts, often with significantly elevated serum beta-HCG. In contrast, our case showed only monomorphic intermediate trophoblasts with no such biphasic arrangement. Therefore, based on the tumor's morphological features—nuclear atypia, myometrial invasion, and necrosis—and the absence of patterns typical of EPSR, ETT, and GCC, we confirmed the diagnosis of PSTT in this case. The postoperative course was favorable. The patient had a regular follow-up every month for the first year combining a clinical examination and a serum level of β-HCG. She had a clinical check-up and pelvic ultrasound every year for two years, no sign of recurrence was noted. Four years after surgery, the patient is still disease free. Figure 2. Macroscopic appearance of the placental site tumor. (A) Peri operative view showing increased uterine size, yellowish area seat (arrow); (B) appearance of the tumor to cut, yellowish tumor occupying the uterine cavity and infiltrating the myometrium. Figure 3. Histological appearance of the placental site tumor. (A) Monomorphic cell proliferation of intermediate trophoblast; (B, C) tumor cells infiltrate the myometrium form of clusters, dissociating smooth muscle bundles (B: low magnification, C: magnification); (D) proliferation of large cells with eosinophilic cytoplasm and lobulated nucleus; (E) home of tumor cells with the presence of vascular emboli. Discussion In 1895, Marchand first described PSTT and named it atypical chorioepithelioma. 4 In 1981, Scully and Young described the morphological details and recognized it as a neoplastic process, and named it PSTT. 5 PSTTs are a rare subtype of gestational trophoblastic disease, accounting for less than 1% of all cases. 1 , 2 , 6 It mainly affects women of childbearing age and it is seen in patients between 19-62 years, with an average age of 30 years. 1 – 3 , 6 , 7 PSTT can occur after a normal pregnancy, abortion, term delivery, ectopic pregnancy or molar pregnancy. 1 – 3 , 6 – 8 Here we reported a case of PSTT occurring after a normal pregnancy. This pathology may occur months to years after pregnancy with the average interval between the antecedent pregnancy and diagnosis being 16 to 18 months. 1 – 3 , 6 , 9 Diagnosis of PSTT can be difficult due to the nonspecific clinical signs. Abnormal uterine bleeding is the most common presenting feature. 1 – 3 , 6 – 9 Metrorrhagia can also be associated with amenorrhea. 1 , 8 In addition to PSTT, other gestational trophoblastic diseases should be discussed in the face of abnormal uterine bleeding in postpartum such as intraplacental choricarcinoma (IC). 10 Diagnosing IC is often delayed because of the lack of specific symptoms. While not always routinely performed, histological examination of the placenta is crucial when clinical warning signs or concerning ultrasound findings are present. Indicators such as sudden fetal distress, fetal or neonatal anemia, perinatal death, and unusual postpartum vaginal bleeding could signify IC associated with foeto-maternal hemorrhage and warrant thorough investigation, including placental histology. Thus, it would be wise to preserve the placenta for 24-48 hours after each birth. 10 The peculiarity of our case lies in the fact that the tumor was manifested by an array of pelvic abscess associated with bleeding; such clinical presentation was rare in literature. 8 On digital pelvic examination, the uterus can be enlarged or normal sized. 2 , 8 A wide range of other rare symptoms have also been reported, including galactorrhea, virilization, nephrotic syndrome, and polycythemia. 2 , 8 PSTT can also be revealed by metastasis. 2 , 7 The serum levels of β-hCG are usually in the range of 1000-2000 mIU/mL. 1 – 3 , 6 , 9 The origin of PSTT is the intermediate trophoblast cells which secrete little beta HCG and a lot of placental lactogenic hormone. 6 , 9 On gross examination, the tumors are located primarily in the Endo myometrium, presenting as polypoid or nodular masses, with a variable diameter up to 10 cm. 1 , 6 The sectioned surfaces of the tumors are solid, often fleshy, and usually yellow with necrosis, and hemorrhage. 1 , 2 , 6 The tumor may extend into the cervix or infiltrate the serous, the adnexa or the round ligaments. 2 In our case, the tumor invaded the myometrium without reaching the serous. The diagnosis of PSTT is based on pathological examination. On microscopic examination, we typically find a proliferation of intermediate trophoblastic cells without chorionic villi, which infiltrate muscle fibers. 2 Vascular invasion, necrosis and hemorrhage are also often observed. 2 The tumor is composed of a relatively monotonous population of polygonal cells with nuclear atypia and moderately abundant cytoplasm that can be amphophilic, eosinophilic or clear. 1 , 2 The distinctive pattern of vascular invasion and deposition of fibrinoid material are the key diagnostic features. 1 – 3 Usually, PSTTs have an unpredictable malignant potential and between 10 and 20% of patients have metastatic disease at the time of presentation. 1 , 2 , 7 , 11 Metastasis site include peritoneum, vagina, lung, liver and brain. Hysterectomy without bilateral oophorectomy is the gold standard in PSTT management. 2 , 11 In fact, this entity is particularly less responding to chemotherapy than hydatiforme mole, invasive mole and choriocarcinoma. 2 , 11 When there is extension beyond the uterus, surgical treatment should be associated to chemotherapy. 2 , 11 Fertility sparing surgery, such as hysteroscopic resection or transperitoneal local uterine excision, may be offered to young patients with nonmetastatic disease who desiring to preserve their fertility. 12 , 13 In addition to the FIGO anatomical staging system, which remains a key prognostic factor for placental site trophoblastic tumor (PSTT) survival, recent studies have identified the interval between the last pregnancy and the initiation of treatment as another crucial prognostic indicator. Specifically, a time interval of more than 48 months between the preceding pregnancy and the onset of treatment has been associated with poorer outcomes. This extended interval is linked to an increased risk of metastasis and a more aggressive disease course, emphasizing the need for early diagnosis and timely treatment in cases of suspected PSTT. Therefore, both FIGO staging and the pregnancy-to-treatment interval should be considered when assessing prognosis and planning management strategies for patients with PSTT. 2 , 7 , 11 , 14 After surgical treatment, patients should be followed up during years to optimize the chance of detecting a relapse or metastasis. 7 , 11 , 13 ‐ 15 There is no consensus regarding the frequency and modalities of follow-up for patients treated for PSTT. However, follow-up must necessarily include a detailed clinical examination and quantitative serum hCG measurement to detect recurrences. Additional radiological examinations may be requested based on clinical symptomatology. 16 Perspectives On future studies related to placental site trophoblastic tumor (PSTT), researchers should focus on several key areas: - Genetic Markers: Understanding these markers could aid in early diagnosis, prognosis, and tailored treatment approaches. - Rare Forms with High hCG levels: Investigation into rare PSTT cases presenting with elevated hCG levels is essential to comprehend their unique pathogenesis and optimize treatment strategies for these atypical cases. - New Chemotherapeutic Agents: Developing secondary chemotherapeutic agents is crucial for patients with primary chemoresistant PSTT, offering potential alternative treatment options for this challenging group. Further research into these areas may lead to significant advancements in the understanding and management of PSTT. Strengths and limitations This case report is interesting since it’s the first reporting PSTT simulating a pelvic abscess. However, PTTT are rare which prevents researchers from realizing large scale studies in order to develop valid management protocols. Conclusion Although PSTTs are extremely rare worldwide, the diagnosis should be considered during the post-partum and post-abortion periods if there is persistent metrorrhagia. After surgical treatment, the follow up is needed to be accurate, to help recognize a relapse or metastasis. Data availability All data underlying the results are available as part of the article and no additional source data are required. Consent Written informed consent for publication of clinical details and clinical images was obtained from the patient. References 1. Bouchet-Mishellany F, Ledoux-Pilon A, Darcha C, et al. : Tumeurs trophoblastiques gestationnelles: a propos d’un cas de tumeur trophoblastique du site placentaire et d’un cas de tumeur trophoblastique epithelioide. Ann. Pathol. 2004; 24 : 167–171. Publisher Full Text 2. Devouassoux-Shisheboran M, Allias F, Mathevet P, et al. : Gynecopathology: Pathologie gynecologique. Cas no 2: tumeur trophoblastique du site d’implantation placentaire. Ann. Pathol. 2012; 32 : 189–193. PubMed Abstract | Publisher Full Text 3. Baergen RN, Rutgers JL, Young RH, et al. : Placental site trophoblastic tumor: a study of 55 cases and review of the literature emphasizing factors of prognostic significance. Gynecol. Oncol. 2006; 100 : 511–520. PubMed Abstract | Publisher Full Text 4. Marchand F: Uber die sogenannten “decidualen” geschwulste im Anschlus an normale Gebart, Abort, Blasenmole und Extrauterine Schwangerschaft. Monatsschr Geburtshilfe Gynaekol 1985; 1 : 419–438. 5. Scully RE, Young RH: Trophoblastic pseudotumor. A reappraisal. Am. J. Surg. Pathol. 1981; 5 : 75–76. PubMed Abstract | Publisher Full Text 6. Mardi K, Kaushal V: Placental site trophoblastic tumor - a challenging, rare entity. Taiwan. J. Obstet. Gynecol. 2010; 49 : 533–535. PubMed Abstract | Publisher Full Text 7. Colecchi C, Partemi S, Minelli N, et al. : Placental site trophoblastic tumor with lung metastases as cause of death in a young patient: A case report. Placenta 2011; 32 : 1060–1063. PubMed Abstract | Publisher Full Text 8. Vuong PN, Guillet JL, Houissa-Vuong S, et al. : Pathologie des tumeurs trophoblastiques gestationnelles. Gynecol. Obstet. Fertil. 2000; 28 : 913–926. Publisher Full Text 9. Yalinkaya A, Ali Irfan Guzel AI, Kangal K, et al. : Two cases of placental site trophoblastic tumor. Taiwan. J. Obstet. Gynecol. 2011; 50 : 372–374. PubMed Abstract | Publisher Full Text 10. Stabile G, Gentile RM, Carlucci S, et al. : Maternal and fetal outcomes of intraplacental choriocarcinoma complicated by fetomaternal hemorrhage: a systematic review . J. Matern. Fetal Neonatal Med .2023; 36 (2): 228–238. PubMed Abstract | Publisher Full Text 11. Sergent F, Verspyck E, Lemoine JP, et al. : Place de la chirurgie dans la prise en charge des tumeurs trophoblastiques gestationnelles. Gynecol. Obstet. Fertil. 2006; 34 : 233–238. Publisher Full Text 12. Chiofalo B, Palmara C, Lagana AS, et al. : Fertility sparing strategies in patients affected by placental site trophoblastic tumor. Curr. Treat. Options Oncol. 2017; 18 (10):58. PubMed Abstract | Publisher Full Text 13. Zhao J, Lv WG, Feng FZ, et al. : Placental site trophoblastic tumor: a review of 108 cases and their implications for prognosis and treatment. Gynecol. Oncol. 2016; 142 :102–108. PubMed Abstract | Publisher Full Text 14. Rauw L, Delbecque K, Goffin F, et al. : Atypical recurrence of a placental site trophoblastic tumor four years after hysterectomy for benign condition: Case report and review of literature. Gynecol. Oncol. Rep. 2013; 6 : 36–38. PubMed Abstract | Publisher Full Text 15. Froeling FEM, Ramaswami R, Papanastasopoulos P, et al. : Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours. Br. J. Cancer. 2019 Mar; 120 (6): 587–594. Epub 2019 Feb 22. PubMed Abstract | Publisher Full Text | Free Full Text 16. RCOG. Gestational Trophoblastic Disease (Green-top Guideline No. 38). Reference Source Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 01 Feb 2022 ADD YOUR COMMENT Comment Author details Author details 1 Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia 2 Department of Pathology, Habib Thameur Hospital, Faculty of Medicine of Tunis, Hbib Thameur Hospital, El Manar, Tunisia Souayeh Nesrine Roles: Conceptualization, Writing – Original Draft Preparation Hajer Bettaieb Roles: Data Curation, Methodology, Resources Wael Mbarki Roles: Resources, Software Ben Brahim Ehsen Roles: Investigation, Methodology Helal Imen Roles: Investigation, Methodology Ben Nasr Mehdi Roles: Writing – Review & Editing Oueslati Hedhili Roles: Validation Hsayaoui Najeh Roles: Formal Analysis, Project Administration, Supervision Chaouki Mbarki Roles: Supervision, Validation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 21 Oct 2024, 11:129 https://doi.org/10.12688/f1000research.75075.3 version 2 Revised Published: 27 Oct 2023, 11:129 https://doi.org/10.12688/f1000research.75075.2 version 1 Published: 01 Feb 2022, 11:129 https://doi.org/10.12688/f1000research.75075.1 Copyright © 2024 Nesrine S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Nesrine S, Bettaieb H, Mbarki W et al. Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.12688/f1000research.75075.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 21 Oct 2024 Revised Views 0 Cite How to cite this report: Stabile G. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.173598.r333450 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v3#referee-response-333450 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Oct 2024 Guglielmo Stabile , Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology,, University of Foggia Departments of Medicine (Ringgold ID: 507873), Foggia, Foggia, Italy Approved VIEWS 0 https://doi.org/10.5256/f1000research.173598.r333450 The manuscript has been improved. ... Continue reading READ ALL The manuscript has been improved. The manuscript is suitable for indexing. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Expert in Placental Pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Stabile G. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.173598.r333450 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v3#referee-response-333450 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Palo S. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.173598.r333452 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v3#referee-response-333452 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Oct 2024 Seetu Palo , All India Institute of Medical Sciences, Hyderabad, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.173598.r333452 Although the authors have added a note on differential diagnoses, further refinement and correction is needed in this section. For example, the authors have mentioned that exaggerated placental site response (EPSR) is characterized by lack of nuclear atypia and invasive behavior, ... Continue reading READ ALL Although the authors have added a note on differential diagnoses, further refinement and correction is needed in this section. For example, the authors have mentioned that exaggerated placental site response (EPSR) is characterized by lack of nuclear atypia and invasive behavior, which is in contrast to existing literature. EPSR can exhibit certain degree of nuclear atypia and it is know to invade the superficial myometrium as well (Ref 1, Ref 2). References 1. Akbayir O, Alkis I, Corbacioglu A, Ekiz A, et al.: Exaggerated placental site reaction detected during caesarean delivery: a case report. Clin Exp Obstet Gynecol . 2012; 39 (2): 234-5 PubMed Abstract 2. Shih IM, Kurman RJ: The pathology of intermediate trophoblastic tumors and tumor-like lesions. Int J Gynecol Pathol . 2001; 20 (1): 31-47 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Palo S. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.173598.r333452 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v3#referee-response-333452 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 27 Oct 2023 Revised Views 0 Cite How to cite this report: Palo S. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.157888.r321955 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v2#referee-response-321955 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Sep 2024 Seetu Palo , All India Institute of Medical Sciences, Hyderabad, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.157888.r321955 This is a well-documented case report on a rare condition, providing valuable insights into the diagnosis and management of placental site trophoblastic tumor (PSTT). Strengthening the discussion around the unique presentation and refinement in structure and depth of discussion, particularly ... Continue reading READ ALL This is a well-documented case report on a rare condition, providing valuable insights into the diagnosis and management of placental site trophoblastic tumor (PSTT). Strengthening the discussion around the unique presentation and refinement in structure and depth of discussion, particularly around clinical implications and differential diagnosis, would improve the manuscript. The description of imaging findings is well-executed, and the figures provide useful visual aids. However, there are some issues with figure referencing and clarity. Figure 1 is briefly mentioned in the text, but the explanation could be expanded to better connect the ultrasound findings to the case narrative. Similarly, the histopathological micro-photographs, which forms the basis of diagnosis, need to be of better resolution with appropriate annotations for better understanding of the readers. The authors should discuss about microscopic differential diagnoses, such as, exaggerated placental site response, epithelioid trophoblastic tumor and gestational choriocarcinoma, and state how were these differentials excluded in this particular case. The description of the surgical management (hysterectomy) is clear, and the follow-up section is well done, providing a clear timeline of surveillance for recurrence, which is crucial in managing PSTT. However, additional information regarding β-HCG levels over time would further strengthen the post-treatment monitoring discussion. A brief note on emerging treatment options or potential prognostic factors could further enrich the discussion. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Palo S. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.157888.r321955 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v2#referee-response-321955 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 21 Oct 2024 chaouki mbarki , Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia 21 Oct 2024 Author Response Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript ... Continue reading Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. Competing Interests: None Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 21 Oct 2024 chaouki mbarki , Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia 21 Oct 2024 Author Response Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript ... Continue reading Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. Competing Interests: None Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Stabile G. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.157888.r321960 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v2#referee-response-321960 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Sep 2024 Guglielmo Stabile , Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology,, University of Foggia Departments of Medicine (Ringgold ID: 507873), Foggia, Foggia, Italy Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.157888.r321960 Dear Authors and Editor, thank you to allow me tor review this interesting case report. In my opinion the subject is very interesting and report is useful for the diagnosis and management of such rare clinical event. In my ... Continue reading READ ALL Dear Authors and Editor, thank you to allow me tor review this interesting case report. In my opinion the subject is very interesting and report is useful for the diagnosis and management of such rare clinical event. In my opinion an important point to be discussed is the possibility to preserve the placenta for 24-48 hours after each birth, to perform histological examination even in the case in which the birth was physiological but particular symptoms appeared in the hours immediately after birth (also in this case, after an in-depth medical history, the bleeding was already abundant after birth. This procedure could led to a better and faster diagnosis of this as well as other even rarer placental pathologies [ref 1] . A few more histological tests would improve the outcomes in terms of survival and fertility sparing of the patients. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Stabile G, Gentile RM, Carlucci S, Stampalija T, et al.: Maternal and fetal outcomes of intraplacental choriocarcinoma complicated by fetomaternal hemorrhage: a systematic review. J Matern Fetal Neonatal Med . 2023; 36 (2): 2285238 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Expert in Placental Pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Stabile G. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.157888.r321960 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v2#referee-response-321960 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 17 Oct 2024 chaouki mbarki , Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia 17 Oct 2024 Author Response Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript ... Continue reading Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 17 Oct 2024 chaouki mbarki , Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia 17 Oct 2024 Author Response Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript ... Continue reading Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 01 Feb 2022 Views 0 Cite How to cite this report: Aniţei MG. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.78892.r159682 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v1#referee-response-159682 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Jan 2023 Maria-Gabriela Aniţei , University of Medicine and Pharmacy, Iasi, Romania Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.78892.r159682 I was pleased to review the article Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess. The methodology used by the authors is appropriate for the purpose of the study and conclusions are narrowly linked to ... Continue reading READ ALL I was pleased to review the article Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess. The methodology used by the authors is appropriate for the purpose of the study and conclusions are narrowly linked to available evidence. The title expresses clearly the content of the manuscript and highlights the importance of the study. As the authors note in Strengths and limitations , this case report is interesting since it is the first reporting of PSTT simulating a pelvic abscess. There was rapid evolution of tumor development, only 2 months after natural birth, apparently without a risk factor from her medical history. There are interesting images intraoperative and microscopy The article respects the presentation algorithm that is required for a case report type article, but there is a number of medical details are missing, such as no detailed investigations (CT-scan, for example) to exclude metastases, both at the time of diagnosis and follow-up. In the same direction, to improve the methodology of this study, the introduction section must be improved. It is too short, and I suggest that some information regarding diagnosis and prognosis of PSTT should be included. Likewise, Immunohistochemistry data and the FIGO score are missing from the anatomopathological presentation, this information would increase the value of the article. Likewise, to be more convincing, the authors could image the patient at a distance through an CT-scan exam to confirm, through this high-performance investigation, the absence of local or distant disease. These tests would help to exclude metastases, both at the time of diagnosis and follow-up, especially as the anatomical-pathological examination shows a vascular invasion. The conclusion of the article could be strengthened. Although PSTTs are extremely rare worldwide, the diagnosis should be considered during the post-partum and postabortion periods if there is persistent metrorrhagia - this means that, in front of a patient with metrorrhagia and febrile syndrome that appeared early after delivery, this differential diagnosis (PSTT) must also be taken into account. Other points: 1. It doesn't seem representative to me that pathology should be a Keywords 2. immunohistochemistry data and the FIGO score are missing from the anatomopathological presentation 3. Usually, 'PSTTs are benign tumors' – I am not agree with this affirmation 4. In figure 3- the microscopy details must be specified - is it an image of HE? , how many times is it amplified ( which objective was used?) . As the area of interest is identified in image D, I recommend that the same thing be done for the other images (Figure 3- A, B, C, E) Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: oncological gynecology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Aniţei MG. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.78892.r159682 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v1#referee-response-159682 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Braga A. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.78892.r125758 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v1#referee-response-125758 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Mar 2022 Antonio Braga , Rio de Janeiro Trophoblastic Disease Center, Antonio Pedro University Hospital, Maternity School of Rio de Janeiro Federal University, Fluminense Federal University, Rio de Janeiro, Brazil Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.78892.r125758 Dear Authors and Editors, I would like to thank you for the opportunity to review the paper entitled: “Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess”, submitted to the F1000. Similarly, I would ... Continue reading READ ALL Dear Authors and Editors, I would like to thank you for the opportunity to review the paper entitled: “Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess”, submitted to the F1000. Similarly, I would like to congratulate the authors for their interest in the topic. In this case report, the authors presented a description of a PSTT presenting as abdominal abscess, reviewing the literature of this subject. I would like to highlight some aspects that deserve attention. The authors must describe in the case report the screening for metastatic disease, to justify the decision for TAH. PSTT is always cancer, not a benign tumor as described. Nowadays we have, besides FIGO anatomical staging system as prognostic factor for PSTT surviving, the interval of last pregnancy and the initiating of treatment of 48 months. 1 In the section 'Strengths and Limitations' there is a PTTT that should be corrected. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Froeling FEM, Ramaswami R, Papanastasopoulos P, Kaur B, et al.: Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours. Br J Cancer . 120 (6): 587-594 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Gestational trophoblastic disease I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Braga A. Reviewer Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.78892.r125758 ) The direct URL for this report is: https://f1000research.com/articles/11-129/v1#referee-response-125758 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 06 Nov 2023 chaouki mbarki , Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia 06 Nov 2023 Author Response Dear reviewer, Thank you for taking the time to review our article and for your valuable feedback. I will address your comments as follows: Regarding your first comment, ... Continue reading Dear reviewer, Thank you for taking the time to review our article and for your valuable feedback. I will address your comments as follows: Regarding your first comment, the patient had undergone a total abdominal hysterectomy after a thoracoabdominopelvic CT scan revealed no metastatic lesions. We have also addressed all the other issues as per your request, which you can verify in the revised version. We would greatly appreciate it if you could approve this paper now that we have made the necessary amendments. Thank you for your assistance. Dear reviewer, Thank you for taking the time to review our article and for your valuable feedback. I will address your comments as follows: Regarding your first comment, the patient had undergone a total abdominal hysterectomy after a thoracoabdominopelvic CT scan revealed no metastatic lesions. We have also addressed all the other issues as per your request, which you can verify in the revised version. We would greatly appreciate it if you could approve this paper now that we have made the necessary amendments. Thank you for your assistance. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 06 Nov 2023 chaouki mbarki , Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia 06 Nov 2023 Author Response Dear reviewer, Thank you for taking the time to review our article and for your valuable feedback. I will address your comments as follows: Regarding your first comment, ... Continue reading Dear reviewer, Thank you for taking the time to review our article and for your valuable feedback. I will address your comments as follows: Regarding your first comment, the patient had undergone a total abdominal hysterectomy after a thoracoabdominopelvic CT scan revealed no metastatic lesions. We have also addressed all the other issues as per your request, which you can verify in the revised version. We would greatly appreciate it if you could approve this paper now that we have made the necessary amendments. Thank you for your assistance. Dear reviewer, Thank you for taking the time to review our article and for your valuable feedback. I will address your comments as follows: Regarding your first comment, the patient had undergone a total abdominal hysterectomy after a thoracoabdominopelvic CT scan revealed no metastatic lesions. We have also addressed all the other issues as per your request, which you can verify in the revised version. We would greatly appreciate it if you could approve this paper now that we have made the necessary amendments. Thank you for your assistance. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 01 Feb 2022 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 Version 3 (revision) 21 Oct 24 read read Version 2 (revision) 27 Oct 23 read read Version 1 01 Feb 22 read read Antonio Braga , Maternity School of Rio de Janeiro Federal University, Fluminense Federal University, Rio de Janeiro, Brazil Maria-Gabriela Aniţei , University of Medicine and Pharmacy, Iasi, Romania Guglielmo Stabile , University of Foggia Departments of Medicine (Ringgold ID: 507873), Foggia, Italy Seetu Palo , All India Institute of Medical Sciences, Hyderabad, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Stabile G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Oct 2024 | for Version 3 Guglielmo Stabile , Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology,, University of Foggia Departments of Medicine (Ringgold ID: 507873), Foggia, Foggia, Italy 0 Views copyright © 2024 Stabile G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript has been improved. The manuscript is suitable for indexing. Competing Interests No competing interests were disclosed. Reviewer Expertise Expert in Placental Pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Stabile G. Peer Review Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.173598.r333450) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-129/v3#referee-response-333450 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Palo S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Oct 2024 | for Version 3 Seetu Palo , All India Institute of Medical Sciences, Hyderabad, India 0 Views copyright © 2024 Palo S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Although the authors have added a note on differential diagnoses, further refinement and correction is needed in this section. For example, the authors have mentioned that exaggerated placental site response (EPSR) is characterized by lack of nuclear atypia and invasive behavior, which is in contrast to existing literature. EPSR can exhibit certain degree of nuclear atypia and it is know to invade the superficial myometrium as well (Ref 1, Ref 2). References 1. Akbayir O, Alkis I, Corbacioglu A, Ekiz A, et al.: Exaggerated placental site reaction detected during caesarean delivery: a case report. Clin Exp Obstet Gynecol . 2012; 39 (2): 234-5 PubMed Abstract 2. Shih IM, Kurman RJ: The pathology of intermediate trophoblastic tumors and tumor-like lesions. Int J Gynecol Pathol . 2001; 20 (1): 31-47 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Palo S. Peer Review Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.173598.r333452) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-129/v3#referee-response-333452 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Palo S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Sep 2024 | for Version 2 Seetu Palo , All India Institute of Medical Sciences, Hyderabad, India 0 Views copyright © 2024 Palo S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a well-documented case report on a rare condition, providing valuable insights into the diagnosis and management of placental site trophoblastic tumor (PSTT). Strengthening the discussion around the unique presentation and refinement in structure and depth of discussion, particularly around clinical implications and differential diagnosis, would improve the manuscript. The description of imaging findings is well-executed, and the figures provide useful visual aids. However, there are some issues with figure referencing and clarity. Figure 1 is briefly mentioned in the text, but the explanation could be expanded to better connect the ultrasound findings to the case narrative. Similarly, the histopathological micro-photographs, which forms the basis of diagnosis, need to be of better resolution with appropriate annotations for better understanding of the readers. The authors should discuss about microscopic differential diagnoses, such as, exaggerated placental site response, epithelioid trophoblastic tumor and gestational choriocarcinoma, and state how were these differentials excluded in this particular case. The description of the surgical management (hysterectomy) is clear, and the follow-up section is well done, providing a clear timeline of surveillance for recurrence, which is crucial in managing PSTT. However, additional information regarding β-HCG levels over time would further strengthen the post-treatment monitoring discussion. A brief note on emerging treatment options or potential prognostic factors could further enrich the discussion. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 21 Oct 2024 chaouki mbarki, Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. View more View less Competing Interests None reply Respond Report a concern Palo S. Peer Review Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.157888.r321955) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-129/v2#referee-response-321955 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Stabile G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Sep 2024 | for Version 2 Guglielmo Stabile , Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology,, University of Foggia Departments of Medicine (Ringgold ID: 507873), Foggia, Foggia, Italy 0 Views copyright © 2024 Stabile G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors and Editor, thank you to allow me tor review this interesting case report. In my opinion the subject is very interesting and report is useful for the diagnosis and management of such rare clinical event. In my opinion an important point to be discussed is the possibility to preserve the placenta for 24-48 hours after each birth, to perform histological examination even in the case in which the birth was physiological but particular symptoms appeared in the hours immediately after birth (also in this case, after an in-depth medical history, the bleeding was already abundant after birth. This procedure could led to a better and faster diagnosis of this as well as other even rarer placental pathologies [ref 1] . A few more histological tests would improve the outcomes in terms of survival and fertility sparing of the patients. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Stabile G, Gentile RM, Carlucci S, Stampalija T, et al.: Maternal and fetal outcomes of intraplacental choriocarcinoma complicated by fetomaternal hemorrhage: a systematic review. J Matern Fetal Neonatal Med . 2023; 36 (2): 2285238 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Expert in Placental Pathology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 17 Oct 2024 chaouki mbarki, Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia Dear Reviewer, Thank you for reviewing our article. I truly appreciate all your remarks and comments. I have made the necessary revisions, which you can find in the revised manuscript (version 3). I hope the updated version meets your approval. Thank you once again. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Stabile G. Peer Review Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.157888.r321960) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-129/v2#referee-response-321960 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 Aniţei M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Jan 2023 | for Version 1 Maria-Gabriela Aniţei , University of Medicine and Pharmacy, Iasi, Romania 0 Views copyright © 2023 Aniţei M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I was pleased to review the article Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess. The methodology used by the authors is appropriate for the purpose of the study and conclusions are narrowly linked to available evidence. The title expresses clearly the content of the manuscript and highlights the importance of the study. As the authors note in Strengths and limitations , this case report is interesting since it is the first reporting of PSTT simulating a pelvic abscess. There was rapid evolution of tumor development, only 2 months after natural birth, apparently without a risk factor from her medical history. There are interesting images intraoperative and microscopy The article respects the presentation algorithm that is required for a case report type article, but there is a number of medical details are missing, such as no detailed investigations (CT-scan, for example) to exclude metastases, both at the time of diagnosis and follow-up. In the same direction, to improve the methodology of this study, the introduction section must be improved. It is too short, and I suggest that some information regarding diagnosis and prognosis of PSTT should be included. Likewise, Immunohistochemistry data and the FIGO score are missing from the anatomopathological presentation, this information would increase the value of the article. Likewise, to be more convincing, the authors could image the patient at a distance through an CT-scan exam to confirm, through this high-performance investigation, the absence of local or distant disease. These tests would help to exclude metastases, both at the time of diagnosis and follow-up, especially as the anatomical-pathological examination shows a vascular invasion. The conclusion of the article could be strengthened. Although PSTTs are extremely rare worldwide, the diagnosis should be considered during the post-partum and postabortion periods if there is persistent metrorrhagia - this means that, in front of a patient with metrorrhagia and febrile syndrome that appeared early after delivery, this differential diagnosis (PSTT) must also be taken into account. Other points: 1. It doesn't seem representative to me that pathology should be a Keywords 2. immunohistochemistry data and the FIGO score are missing from the anatomopathological presentation 3. Usually, 'PSTTs are benign tumors' – I am not agree with this affirmation 4. In figure 3- the microscopy details must be specified - is it an image of HE? , how many times is it amplified ( which objective was used?) . As the area of interest is identified in image D, I recommend that the same thing be done for the other images (Figure 3- A, B, C, E) Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise oncological gynecology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Aniţei MG. Peer Review Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.78892.r159682) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-129/v1#referee-response-159682 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2022 Braga A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Mar 2022 | for Version 1 Antonio Braga , Rio de Janeiro Trophoblastic Disease Center, Antonio Pedro University Hospital, Maternity School of Rio de Janeiro Federal University, Fluminense Federal University, Rio de Janeiro, Brazil 0 Views copyright © 2022 Braga A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors and Editors, I would like to thank you for the opportunity to review the paper entitled: “Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess”, submitted to the F1000. Similarly, I would like to congratulate the authors for their interest in the topic. In this case report, the authors presented a description of a PSTT presenting as abdominal abscess, reviewing the literature of this subject. I would like to highlight some aspects that deserve attention. The authors must describe in the case report the screening for metastatic disease, to justify the decision for TAH. PSTT is always cancer, not a benign tumor as described. Nowadays we have, besides FIGO anatomical staging system as prognostic factor for PSTT surviving, the interval of last pregnancy and the initiating of treatment of 48 months. 1 In the section 'Strengths and Limitations' there is a PTTT that should be corrected. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Froeling FEM, Ramaswami R, Papanastasopoulos P, Kaur B, et al.: Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours. Br J Cancer . 120 (6): 587-594 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Gestational trophoblastic disease I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 06 Nov 2023 chaouki mbarki, Department of Obstetrics and Gynecology, Ben Arous Hospital, Faculty of Medicine, Ben Arous Hospital, El Manar, Tunisia Dear reviewer, Thank you for taking the time to review our article and for your valuable feedback. I will address your comments as follows: Regarding your first comment, the patient had undergone a total abdominal hysterectomy after a thoracoabdominopelvic CT scan revealed no metastatic lesions. We have also addressed all the other issues as per your request, which you can verify in the revised version. We would greatly appreciate it if you could approve this paper now that we have made the necessary amendments. Thank you for your assistance. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Braga A. Peer Review Report For: Case Report: Placental site trophoblastic tumor revealed by a clinical pelvic abscess [version 3; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :129 ( https://doi.org/10.5256/f1000research.78892.r125758) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-129/v1#referee-response-125758 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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