The aim of this review is to provide an overview of existing literature and current knowledge on fertility rates and reproductive outcomes after gestational trophoblastic disease. A systematic literature search was performed to retrieve all available studies on fertility rates and reproductive outcomes after hydatidiform mole pregnancy, low-risk gestational trophoblastic neoplasia, high- and ultra-high-risk gestational trophoblastic neoplasia, and the rare placental site trophoblastic tumor and epithelioid trophoblastic tumor forms of gestational trophoblastic neoplasia. The effects of single-agent chemotherapy, multi-agent including high-dose chemotherapy, and immunotherapy on fertility, pregnancy wish, and pregnancy outcomes were evaluated and summarized. After treatment for gestational trophoblastic neoplasia, most, but not all, women want to achieve another pregnancy. Age and extent of therapy determine if there is a risk of loss of fertility. Single-agent treatment does not affect fertility and subsequent pregnancy outcome. Miscarriage occurs more often in women who conceive within 6 months of follow-up after chemotherapy. Multi-agent chemotherapy hastens the natural menopause by three years and commonly induces a temporary amenorrhea, but in young women rarely causes permanent ovarian failure or infertility. Subsequent pregnancies have a high chance of ending with live healthy babies. In contrast, high-dose chemotherapy typically induces permanent amenorrhea, and no pregnancies have been reported after high-dose chemotherapy for gestational trophoblastic neoplasia. Immunotherapy is promising and may give better outcomes than multiple schedules of chemotherapy or even high-dose chemotherapy. The first pregnancy after immunotherapy has recently been described. Data on fertility-sparing treatment in placental site trophoblastic tumor and epithelioid trophoblastic tumor are still scarce, and this option should be offered with caution. In general, patients with gestational trophoblastic neoplasia may be reassured about their future fertility and pregnancy outcome. Detailed registration of high-risk gestational trophoblastic neoplasia is still indispensable to obtain more complete data to better inform patients in the future.
Introduction/Background* Gestational trophoblastic neoplasia comprises a unique group of human neoplastic diseases that derive from fetal trophoblastic tissues. The hydatidiform mole is the most common form of GTD, representing 80 percent of cases. An invasive mole is a hydatidiform mole characterized by the enlarged hydropic villi invading into the myometrium, into vascular spaces, or into extrauterine sites. Methodology Case presentation: Here is a case with invasive mole after the evacuation of complete molar pregnancy, presented with an acute abdomen. We desired to preserve the uterine because our 21 years old patient doesn't have a child. Result(s)* Clinical Discussion An emergency abdominal ultrasound scan showed a 47*34*55 mm ill-defined hyperechoic heterogeneous mass with anechoic cystic vascular spaces within it, in the posterior wall of the uterus away from the endometrium that extended to the serous layer of the uterus. Laparotomy was done. After the evacuation of 2 L of hemoperitoneum, an approximately 5×4 metastatic, vesicular mass was seen in the posterior wall of the uterus, which was resected and uterine preservation was successful. Conclusion* This case report describes the clinical, imaging, surgical and histopathological findings of Invasive mole after a hydatidiform molar pregnancy. Our case highlights the feasibility of fertility-preserving surgery in the case who experienced life-threatening hemorrhage due to a ruptured uterus.
BackgroundGestational trophoblastic disease (GTD) refers to a group of rare tumors originating in the syncytiotrophoblast, cytotrophoblast or intermediate trophoblast of the placenta. Epitheloid Trophoblastic Tumor
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