Recurrent trophoblastic neoplasia

Abstract

An unusual case of recurrent benign trophoblastic growth occurring for the fourth time in a gravida 4, para 0, 30-year-old woman is reported. Prophylactic chemotherapy was instituted to avert the disaster again, without success. The question of her future obstetric outcome poses a formidable dilemma and no radical measures could be undertaken, as the patient hoped for a normal pregnancy.

A case report of a patient with 12 consecutive complete molar pregnancies

“…The malignant behavior of moles is increased with each subsequent recurrence ( 1 , 6 ) . Our patient, however, did not have any obvious worsening of her trophoblastic disease despite twelve consecutive recurrences, similar to the experience elsewhere ( 2 –5 ) . Not withstanding the relative rarity of recurrent molar pregnancy, more studies are needed to identify if, and which, circumstances favor recurrence of the same benign trophoblastic process and to determine the exact probability of malignancy in recurrent disease.…”

“…Additional factors other than those responsible for persistent trophoblastic disease are probably involved because the incidence of subsequent recurrence of a mole is almost double that of malignant complications in those patients ( 1 ) . Suggested immunologic and genetic risk factors are unlikely to be respons‐ible in the case described here because all pregnancies were from the same husband, his karyotype was normal and there was no consanguinity nor a history of molar pregnancy in the patient family ( 2 –6 ) . The malignant behavior of moles is increased with each subsequent recurrence ( 1 , 6 ) .…”

“…The results may have an important bearing on the contraceptive advice given to affected patients. The relative scarcity of case reports of recurrent complete molar pregnancies in the most recent two decades compared to the previous two decades, despite better diagnostic facilities and concomitant decrease in the use of hysterectomy in treatment of moles, is noteworthy ( 1 –6 ) . It will be interesting to know whether this observation reflects progress in diagnosis and management of molar pregnancy over the years, a decrease in gravidity or a changing pattern of etiologic factors.…”

“…Management of patients with recurrent consecutive moles becomes extremely difficult in certain countries, like Egypt, where the importance of having children is a deeply‐rooted cultural value. Future pregnancy is always desired by such patients, irrespective of the number of recurrences ( 2 ) . The fact that molar pregnancies occur frequently in those regions increases the management quandary.…”

“…Recurrent molar pregnancy occurs in 0.6–2.6% of patients with complete moles, some 78 such cases having been reported in the recent literature ( 1 –4 ) . A case of complete molar pregnancy occurring for the twelfth consecutive time is described and the dilemma of management presented as the patient continues to hope for a normal pregnancy.…”