A Novel Approach to The Management of Gestational Trophoblastic Neoplasia

Abstract

Background: Gestational trophoblastic neoplasia following spontaneous abortion is rare and in majority cases the approach is hysterectomy followed by chemotherapy. Case: We present case of a 22-year-old woman who presented with complaints of vaginal bleeding for 2 months; pain abdomen for 3-4 days. On reviewing history, patient was one and a half months pregnant and had spontaneous abortion for which she underwent twice dilatation and curettage and once laparotomy in outside hospital. Patient continued to bleed & MRI pelvis was done which revealed arteriovenous malformation and was thereafter referred to our hospital. On presentation her vitals were stable with pallor positive. On per-abdominal examination there was generalized tenderness and mild bleeding on per speculum examination. Her serum beta hCG at the time of admission was 98,156IU/L. Ultrasound pelvis revealed a highly vascular heterogenous hypoechoic mass showing significant internal and peripheral vascularity. We decided for uterine artery embolization owing to highly vascular GTN, young age and no live issues with the aim of uterine preservation. This was followed by chemotherapy with serial beta hcg monitoring. She is in her 14th month of follow up with resolution of her complaints. Conclusion: The aim behind presenting this case is its rarity of presentation as well as management to increase awareness among treating gynecologists. Importance of multi-disciplinary approach should not be undermined in challenging cases.