Identification and treatment of gestational trophoblastic neoplasia located in the cesarean scar.

Abstract

OBJECTIVE:

To identify the clinical characteristics of, and the diagnostic and therapeutic strategies for, gestational trophoblastic neoplasia (GTN) located in the cesarean scar.

METHODS:

The present retrospective analysis was conducted among patients diagnosed with GTN located in the cesarean scar at Peking Union Medical College Hospital, Beijing, China, between June 1, 2006, and May 31, 2016. Clinical features, diagnostic and therapeutic procedures, and outcomes were reviewed.

RESULTS:

Of 938 women diagnosed with GTN, 31 (3.3%) patients had GTN located in the cesarean scar. Irregular vaginal bleeding was the main clinical manifestation. Twenty (65%) patients received an accurate diagnosis based on a history of molar pregnancy/a high β-human chorionic gonadotropin level/typical imaging presentations. The remaining 11 patients were initially misdiagnosed; the definitive diagnosis was made by pathology. All patients received chemotherapy; 22 (71%) women also underwent hysterectomy or localized uterine lesion resection because of chemoresistant lesions. All patients had a complete remission; at a median follow-up of 35 months, only 1 (3%) woman had a relapse.

CONCLUSION:

Owing to its rarity and nonspecific symptoms, GTN located in the cesarean scar is prone to misdiagnosis. In patients without typical manifestations, the definitive diagnosis often relies on pathology. For treatment, uterine lesion resection is a useful adjunct to chemotherapy.

• Authors: Xiaoyu Wang, Yuan Li, Junjun Yang, Yonglan He, Ming Wang, Xirun Wan, Yang Xiang
• Journal: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (Int J Gynaecol Obstet) Vol. 141 Issue 2 Pg. 222-227 (May 2018) ISSN: 1879-3479 [Electronic] United States
• PMID: 29214637 (Publication Type: Journal Article)
• Copyright: © 2017 International Federation of Gynecology and Obstetrics.

Chemical References

• Chorionic Gonadotropin, beta Subunit, Human

Topics

• Adult
• China
• Chorionic Gonadotropin, beta Subunit, Human
• Cicatrix (pathology)
• Female
• Gestational Trophoblastic Disease (diagnosis, pathology)
• Humans
• Hydatidiform Mole (diagnosis, epidemiology)
• Hysterectomy
• Middle Aged
• Pregnancy
• Retrospective Studies
• Young Adult