When stage does not reflect risk: A case of FIGO Stage I high-risk gestational trophoblastic neoplasia successfully treated with etoposide, methotrexate, and actinomycin D-cyclophosphamide and vincristine

Abstract

Gestational trophoblastic neoplasia (GTN) encompasses a range of trophoblastic disorders characterized by elevated serum beta-human chorionic gonadotropin (β-hCG) levels and notable sensitivity to chemotherapy. Although invasive mole is the most common subtype of GTN, bulky uterine disease with extensive myometrial invasion and serosal involvement pose diagnostic and therapeutic challenges. We report a case of a 45-year-old multiparous woman who presented with lower abdominal pain one month following suction evacuation for molar pregnancy. Histopathological examination revealed residual incomplete molar tissue. Pelvic magnetic resonance imaging revealed a bulky uterus with a posterior myometrial lesion showing loss of interface with the uterine serosa and abutment of the left ovary. The serum β-hCG level was significantly high at 159,407 mIU/mL. Imaging studies, including computed tomography of the thorax and abdomen as well as magnetic resonance imaging of the brain, revealed no signs of metastatic disease. The patient was diagnosed with non-metastatic GTN and treated with multi-agent EMA-CO chemotherapy. Serial β-hCG monitoring demonstrated a rapid decline with eventual normalization. Consolidation chemotherapy was administered after biochemical remission. Despite treatment-related hematological toxicity requiring transfusion support, the patient completed therapy successfully. β-hCG remained within normal limits during follow-up.