Successful Primary Treatment of a Hydatidiform Mole with Methotrexate and EMA/CO

M De Vos,M Leunen,C Fontaine,Ph De Sutter

doi:10.1155/2009/454161

Abstract

Background. The preferred treatment method of most hydatidiform moles is suction aspiration. In rare circumstances uterine abnormalities may preclude surgical treatment. Case. We report a case of complete molar pregnancy successfully treated with methotrexate followed by EMA/CO. A 38-year-old woman with a complete hydatidiform mole and multiple uterine fibroids underwent a failed attempt at suction aspiration. Following treatment with methotrexate, a nonmetastatic persistent trophoblastic tumour developed. Six cycles of EMA/CO led to complete remission. Conclusion. We propose that primary treatment of molar pregnancies with chemotherapy is a useful treatment option in cases where uterine abnormalities interfere with suction aspiration.

Highlights

With an incidence of approximately 0.5 to 1 in 1000 pregnancies in Caucasians, hydatidiform mole (HM) is a relatively rare disorder of trophoblast proliferation, with broad variations in incidence worldwide [1]
A complete hydatidiform mole confers a greater malignant potential: 15 to 20% of CHM will eventually develop into a gestational trophoblastic tumour requiring the administration of chemotherapy, as compared to only 2 to 4% of partial hydatidiform mole (PHM) [2]
In contrast with its use in low-risk nonmetastatic gestational trophoblast neoplasia (GTN) following suction curettage, there are no reports of the use of methotrexate as the primary treatment of a hydatidiform mole located within the uterine cavity

Summary

Background

The preferred treatment method of most hydatidiform moles is suction aspiration. In rare circumstances uterine abnormalities may preclude surgical treatment. We report a case of complete molar pregnancy successfully treated with methotrexate followed by EMA/CO. A 38-year-old woman with a complete hydatidiform mole and multiple uterine fibroids underwent a failed attempt at suction aspiration. Six cycles of EMA/CO led to complete remission. We propose that primary treatment of molar pregnancies with chemotherapy is a useful treatment option in cases where uterine abnormalities interfere with suction aspiration

Introduction

Case Presentation

Findings

Discussion