Title: Role of Uterine Artery Ligation and Chemotherapy in Atypical Cases of Gestational Trophoblastic Disease: A Case Report of Atypical GTD Diagnosis & Management

Authors: Poonam Maggo, Sushant Mittal

 DOI: https://dx.doi.org/10.18535/jmscr/v12i02.07

Abstract

Introduction

Gestational trophoblastic disease[1[i]] is a rare developmental form of proliferative trophoblastic tissue in women of reproductive age that involves both benign and malignant entities that include hydatidiform mole (complete or partial), choriocarcinoma, invasive mole, epithelioid trophoblastic tumor (ETT), and placental site trophoblastic tumor (PSTT). Four of these known as gestational trophoblastic neoplasia [2[ii]], and hydatidiform is most common type of GTD. Gestational trophoblastic neoplasia (GTN) is a type of gestational trophoblastic disease that is almost always malignant, and can metastasize and be fatal if not treated. The ultimate treatment for GTD includes surgery (evacuation of the proliferative trophoblastic tissue, hysterectomy), chemotherapy regimens, radiotherapy and emerging targeted therapies. It is one of the most chemotherapy responsive and highly curable cancer. In most instances, it is cured by surgical evacuation of the uterus. If persistent, it is treated with chemotherapy which provides response in >90% of the cases. In the unresponsive persistent cases and if the women has completed her child bearing, hysterectomy is generally recommended. Here, we report a case of atypical GTD {uncommon, that is not fitting a single diagnosis} treated by chemotherapy and bilateral uterine artery ligation.

 

References

[1] Seckl, M. J., Sebire, N. J., & Berkowitz, R. S. (2010). Gestational trophoblastic disease. Lancet (London, England)376(9742), 717–729. https://doi.org/10.1016/S0140-6736(10)60280-2

 [2] Berkowitz, R. S., & Goldstein, D. P. (2002). In: Berck JS. Gestational trophoblastic neoplasm.

[3] Lurain J. R. (2010). Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. American journal of obstetrics and gynecology203(6), 531–539. https://doi.org/10.1016/j.ajog.2010.06.073

[4] FIGO Oncology Committee (2002). FIGO staging for gestational trophoblastic neoplasia 2000. FIGO Oncology Committee. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics77(3), 285–287. https://doi.org/10.1016/s0020-7292(02)00063-2

[5] Yarandi, F., Eftekhar, Z., Shojaei, H., Kanani, S., Sharifi, A., & Hanjani, P. (2008). Pulse methotrexate versus pulse actinomycin D in the treatment of low-risk gestational trophoblastic neoplasia. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics103(1), 33–37. https://doi.org/10.1016/j.ijgo.2008.05.013

[6] Goldstein, D. P., & Berkowitz, R. S. (2012). Current management of gestational trophoblastic neoplasia. Hematology/oncology clinics of North America26(1), 111–131. https://doi.org/10.1016/j.hoc.2011.10.007

[7] Lurain J. R. (2011). Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. American journal of obstetrics and gynecology204(1), 11–18. https://doi.org/10.1016/j.ajog.2010.06.072\

[8] Kani, K. K., Lee, J. H., Dighe, M., Moshiri, M., Kolokythas, O., & Dubinsky, T. (2012). Gestatational trophoblastic disease: multimodality imaging assessment with special emphasis on spectrum of abnormalities and value of imaging in staging and management of disease. Current problems in diagnostic radiology41(1), 1–10. https://doi.org/10.1067/j.cpradiol.2011.06.002

[9] Allen, S. D., Lim, A. K., Seckl, M. J., Blunt, D. M., & Mitchell, A. W. (2006). Radiology of gestational trophoblastic neoplasia. Clinical radiology61(4), 301–313. https://doi.org/10.1016/j.crad.2005.12.003

[10] Ngan, H. Y. S., Seckl, M. J., Berkowitz, R. S., Xiang, Y., Golfier, F., Sekharan, P. K., Lurain, J. R., & Massuger, L. (2018). Update on the diagnosis and management of gestational trophoblastic disease. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics143 Suppl 2, 79–85. https://doi.org/10.1002/ijgo.12615

Corresponding Author

Poonam Maggo