Gestational trophoblastic neoplasia: A unique challenge in caesarean scar pregnancy

Tambe, Sanjaykumar G.; Goel, Khushboo; Sambharam, Kavita

doi:10.1016/j.ejogrb.2021.06.050

Cited by 5 publications

(4 citation statements)

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“…However, the patient had a temporary recurrence and died of tumor progression 39 months later after the surgery, as the final diagnosis was GTN in the caseation scar. For the patient in Case 2, we believed chemotherapy was acceptable to preserve her fertility as Tambe et al had done, [ 3 ] and histopathological diagnosis is not mandatory for GTN patients.…”

Section: Discussionmentioning

confidence: 96%

“…[ 2 ] Due to this very low incidence, few cesarean scar GTN patients can obtain a clinical diagnosis before pathological examination, especially GTNs following nonmolar pregnancy, and this delay often leads to heavy bleeding or hysterectomy. [ 1 , 3 ] Here, we share our experience in the diagnosis and treatment of 2 patients with uterine cesarean scar mass: the first patient was diagnosed with CSP, and the second was diagnosed with cesarean scar GTN. Medical history, beta-human chorionic gonadotropin (hCG) measurements, and magnetic resonance imaging (MRI) helped us make the correct preoperative diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Case report: Two rare uterine cesarean scar mass cases

et al. 2023

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Rationale: Gestational trophoblastic neoplasia (GTN) located in the cesarean scar is a rare disease that has imaging appearances similar to those of an exogenous scar incision pregnancy and is often misdiagnosed due to insufficient clinical experience. Patient concerns: We report 2 cases of uterine cesarean scar mass. Two patients with different diagnoses had similar clinical complaints as abnormal vaginal bleeding, enlargement of uterus isthmus by physical examination, and mixed echo mass in uterine low segment by ultrasound examination; however, their magnetic resonance imaging images showed very different features. Diagnoses: One patient was diagnosed with cesarean scar pregnancy (CSP) and one patient was diagnosed with cesarean scar GTN. Interventions: The CSP patient underwent surgery by laparoscopy combined with hysteroscopy after uterine artery embolism and obtained pathological confirmation. The GTN patient received chemotherapy. Outcomes: For the CSP patient, her serum β-human chorionic gonadotropin (hCG) concentration returned to normal 2 weeks later, and B-ultrasound showed that the niche was completely repaired 3 months after the operation. The intrauterine lesions of the GTN patient disappeared completely 3 months after serum β-hCG normalization. And her β-hCG was normal at all follow-up visits until now. Lessons: Clinicians should consider GTN when identifying masses at scar incision sites. Magnetic resonance imaging images improve the understanding of the imaging features in patients suspected of having CSP/GTN.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Case report: Two rare uterine cesarean scar mass cases

et al. 2023

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“…Correct primary diagnosis is the cornerstone of treatment for GTN in the cesarean scar, and can prevent severe complications of massive bleeding and uterine perforation [2][3][4][5][6][7][8][9]. Abnormal vaginal bleeding, increase in β-hCG level, typical imaging signs on TVS and MRI can facilitate a diagnosis of GTN in the cesarean scar [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…One woman experienced four episodes of relapse and died of tumor progression 39 months after initial laparoscopic uterine lesion resection. Among the 45 reported cases of GTN in the cesarean scar, hysterectomy was performed in 24 (53%) patients and the uterus was preserved in 21 (47%) patients [2][3][4][5][6][7][8][9]. Preservation of the uterus helps preserve fertility, and 2 of 4 women who attempted pregnancy conceived [2].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of ultrasound-guided focused ultrasound ablation for gestational trophoblastic neoplasia in the cesarean scar: a case report

Chen

Jiang

et al. 2022

BMC Women's Health

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Background The treatment of gestational trophoblastic neoplasia (GTN) is one of the success stories in medical oncology. GTN in the cesarean scar is a rare entity, but most cases need to be treated with hysterectomy or localized uterine lesion resection because of chemoresistant lesions and/or massive bleeding. We present a patient with post-molar GTN in the cesarean scar who was non-invasively treated with ultrasound-guided high intensity focused ultrasound (HIFU) to preserve the uterus and fertility. Case presentation A 32-year-old woman was diagnosed with low-risk GTN (FIGO Stage I: 2 prognostic score) after partial hydatidiform mole. The 5th cycle of chemotherapy was interrupted because of persistent hepatic toxicity and impaired ovarian reserve function. However, the uterine lesion persisted (diameter of residual uterine lesion in the cesarean scar: 2.0 cm). Therefore, ultrasound-guided HIFU treatment was performed. A significant gray-scale change was observed during the HIFU treatment. Color Doppler ultrasonography and contrast-enhanced ultrasound (CEUS) was performed to evaluate the ablation effectiveness. Color Doppler ultrasonography showed disappearance of the signal of vascularity and CEUS showed no perfusion in the lesion located in the cesarean scar. The uterine lesion was obviously shrunken one month after HIFU treatment. Menstrual cycle resumed 48 days after HIFU. HIFU treatment decreased the number of chemotherapy cycles and there was complete disappearance of the GTN lesion at 4-month follow-up. The patient has shown no signs of recurrence as of 58-month follow-up. Conclusion Ultrasound-guided HIFU may be a useful alternative to lesion resection for GTN in the cesarean scar in patients who show chemoresistance or are not suitable for chemotherapy. It has the potential to ablate the residual uterine lesion noninvasively to preserve the uterus and fertility, avoiding perioperative risks of lesion resection, especially acute bleeding.

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Invasive Hydatidiform Mole

Xie

2023

MRI of Gynaecological Diseases

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Gestational trophoblastic neoplasia: A unique challenge in caesarean scar pregnancy

Cited by 5 publications

References 4 publications

Case report: Two rare uterine cesarean scar mass cases

Case report: Two rare uterine cesarean scar mass cases

Long-term outcome of ultrasound-guided focused ultrasound ablation for gestational trophoblastic neoplasia in the cesarean scar: a case report

Invasive Hydatidiform Mole

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