Gestational trophoblastic tumor in pregnancy: a case report and review of the literature

Abstract

A case of gestational trophoblastic tumor (GTT) concurrent with an intrauterine pregnancy is reported in a 21-year-old gravida 2 para 0 (0010) who presented with dyspnea, orthopnea, headache, and blurring of vision at 33 weeks age of gestation. She had a history of hydatidiform mole for which curettage was done. Chest radiograph showed pulmonary metastases, with pleural effusion on both lungs. Serum beta subunit of human chorionic gonadotropin was abnormally elevated for age of gestation. Due to worsening maternal pulmonary condition, the patient underwent primary, low segment cesarean section and was subsequently started on multidrug chemotherapy. This is the first reported case of GTT in pregnancy in the Philippines in which both the mother and the infant survived. Several hypotheses regarding its origin, its diagnosis, and its management and prognosis are presented. This case report emphasizes the importance of early diagnosis and treatment to improve the prognosis of both the mother and the infant.

Invasive Hydatidiform Mole Showing Resistance to Single Etoposide Chemotherapy

“…In normal pregnancy, the serum β-hCG level reaches a peak of 50,000-100,000 mIU/mL at about 12 weeks of gestation, decreases to 10,000-20,000 mIU/mL by 20 weeks and remains at that level until term 4) . Invading trophoblasts from hydatidiform moles and choriocarcinomas secrete higher amounts of hCG compared with trophoblasts in a normal pregnancy 5) .…”

Treatment and monitoring protocols for gestational trophoblastic disease

“…Tokom sukcione kiretaže gubitak krvi je najmanji, kao i mogućnost embolizacije ili širenja trofoblastnog tkiva. Intervenciju treba izvoditi uz infuziju oksitocina, koju treba započeti posle dilatacije i uklanjanja manje količine molarnog tkiva (11). Posle sukcione kiretaže treba nastaviti sa nežnom, oštrom kiretažom.…”

“…Primena oštre kiretaže posle sukcije korisna je jer omogućava potpuno odstranjivanje tkiva priljubljenog uz zid uterusa i osigurava kompletnu evakuaciju. Deo tkiva dobijenog evakuacijom i oštrom kiretažom (dobijeno tkivo decidue bazalis), neophodno je poslati na histopatološki pregled (11,12). Histerotomija u modernom tretmanu GTB nema mesta ovoj intervenciji, jer su komplikacije velike (veći gubitak krvi, veći postoperativni morbiditet, ožiljak na uterusu).…”