Fertility-Sparing Cornual Wedge Resection for Management of GTN

Abstract

<h3>Study Objective</h3> To describe the case of a 30-year-old female with cornual ectopic pregnancy treated with methotrexate with normalization of beta-hCG who subsequently developed GTN at the prior ectopic site. The patient desired future fertility and was treated with actinomycin-D with optimal response and negative beta-hCG for four months, yet the mass was persistent. The patient desired future fertility, and with guidance from gynecologic oncology and reproductive endocrinology, decision was made to proceed with a conservative operation. We demonstrate the technique of cornual wedge resection for treatment of GTN. <h3>Design</h3> Case-report <h3>Setting</h3> The patient was placed in dorsal lithotomy position with lower extremities in Allen-type stirrups and was placed in steep Trendelenburg position. <h3>Patients or Participants</h3> N/A - single patient, case report <h3>Interventions</h3> Actinomycin-D administered until beta-hCG negative for 4 months, mass noted to be persistent at uterine cornu, laparoscopic cornual wedge resection for removal of GTN given patient's desire to maintain future fertility <h3>Measurements and Main Results</h3> Pathology of the mass demonstrated necrotic chorionic villi and placental remnants, negative for malignancy. Follow up transvaginal ultrasound 3 months postoperatively demonstrated no residual mass and no uterine defect. Checking beta-hCG monthly until 12 months with negative tests, then will attempt to conceive with support from reproductive endocrinology and planned cesarean delivery similar to the management of patient's post-myomectomy. <h3>Conclusion</h3> With subspecialty support from gynecologic oncology and reproductive endocrinology, cornual wedge resection should be considered a viable option for treatment of GTN in patients who desire future fertility.