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.
Yufang Liang, Yini Wei, Fangfang Jing et al.
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Case in brief
A 23-year-old woman had persistently plateaued serum human chorionic gonadotropin after hysteroscopic management for suspected incomplete abortion. Imaging showed a deeply invasive, hypervascular uterine lesion with a uterine arteriovenous fistula, prompting strong suspicion of gestational trophoblastic neoplasia; expert pathology review later confirmed placental site trophoblastic tumor (PSTT). Because she wished to preserve fertility and faced high surgical risk, ultrasound-guided high-intensity focused ultrasound (HIFU) was used to reduce vascularity. HIFU did not fully ablate the tumor, but subsequent low-dose chemotherapy led to complete biochemical remission and radiologic regression. No major HIFU-related complications occurred, and menstruation resumed.
What made this case unusual
The PSTT was complicated by a uterine arteriovenous fistula, and HIFU was used not as definitive tumor ablation but as a fertility-preserving vascular-modulating bridge to chemotherapy.
Diagnostic / clinical pearl
In a patient with plateaued human chorionic gonadotropin and a deeply invasive hypervascular uterine lesion, consider gestational trophoblastic neoplasia; expert pathological review may establish PSTT even when imaging raises suspicion rather than confirming the diagnosis.
Why it matters
This case illustrates a potential adjunctive role for HIFU in selected patients with vascular PSTT when surgery carries substantial bleeding and fertility risks, while underscoring that large or deeply invasive lesions may require subsequent systemic therapy.