Fertility-sparing surgery, with subsequent pregnancy, in persistent gestational trophoblastic neoplasia: Case report

Abstract

Gestational trophoblastic neoplasia (GTN) is primarily a disease of women of reproductive age. In most instances, it is cured by surgical evacuation of the uterus, with persistent disease being very sensitive to chemotherapy. Hysterectomy, recommended for persistent chemotherapy-resistant uterine disease, may be unacceptable to the woman who wishes to maintain her fertility. Uterine resection of localized disease, with uterine reconstruction, may be a viable alternative. A case is presented of a woman with persistent uterine GTN, treated with localized uterine resection and reconstruction, followed by two successful pregnancies and deliveries. The literature is reviewed and potential pregnancy complications of this management, particularly uterine rupture, are discussed.

Fertility-Sparing Hysterotomy in Malignant Trophoblastic Tumours Treatment

“…There are few publications, describing urgent localized uterine resection, followed by uterine reconstruction [6,[14][15][16][17][18]. The limited number of clinical observations is apparently caused by the fact that such treatment option was considered as wrong earlier.…”

Uterine Rupture in Twin Pregnancy with Normal Fetus and Complete Hydatidiform Mole

“…Some authors have recommended using ultrasound to monitor uterine thickness in pregnant patients with uterine scars, with results showing an inverse correlation between lower uterine segment thickness and the risk of rupture. However, because data are lacking on the thickness at which the risk of rupture starts increasing considerably, such an approach is only useful for the implementation of an ‘action plan' in the event of uterine rupture and controlled delivery by Cesarean section in a preterm but viable gestation [18]. It is less useful in nonviable gestations, as in our case.…”

Spontaneous Uterine Rupture in Choriocarcinoma During Chemotherapy: A Case Report and Literature Review

“…Diagnosis and treatment of molar pregnancy achieved with surgical evacuation of uterus by dilatation and curettage in more than 80% of cases. Because of high chemosensitivity of the tumor, total cure rate reached above 90% even in the presence of persistent or metastatic lesions (2). If the patient has completed her childbearing and tumour confined to the uterus, hysterectomy is recommended (6).…”

“…Choriocarcinoma is one of the most severe form of GTDs and characterized by local invasion with distant metastasis (1,2). Rapid growth and myometrial invasion may be followed by uterine perforation (3).…”

“…Total abdominal hysterectomy was done. (2). GTD can be malignant and benign, also disseminate by local invasion or distant metastasis.…”