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The role of hysterotomy in the management of gestational trophoblastic neoplasia
  1. W. A.A. Tjalma* and
  2. J. B. Vermorken
  1. *Department of Gynecology and Gynecological Oncology, University Hospital Antwerpen (UZA), Antwerpen, Belgium
  2. Department of Medical Oncology, University Hospital Antwerpen (UZA), Antwerpen, Belgium
  1. Address correspondence and reprint requests to: Wiebren A. A. Tjalma, MD, PhD, Department of Gynecology and Gynecological Oncology, University Hospital Antwerpen (UZA), Wilrijkstraat 10, 2650 Edegem Antwerpen, Belgium. Email: wiebren.tjalma{at}


The management of late gestational trophoblastic disease recurrence is challenging. We present a case of a 16-year-old woman who was diagnosed with a gestational trophoblastic neoplasia 14 months after her hydatidiform mole pregnancy. A staging was performed revealing only an intramural lesion, which resembled a myoma, in the fundus of the uterus. Despite two course of methotrexate, the human chorionic gonadotropin (hCG) level increased slowly. The presentation was highly suggestive for a placental site trophoblastic tumor. A local resection of the tumor by hysterotomy was performed. Pathologic examination revealed a choriocarcinoma with tumor-free surgical margins. Subsequently, the patient received three cycles of EMA-CO (etoposide, methotrexate, actinomycin, cyclophosphamide, and vincristine). At present, 89 months after the hysterotomy, the patient is well, with no sings of recurrence. This report illustrates that it is mandatory to have a histologic diagnosis of chemoresistant gestational trophoblastic neoplasia before performing definitive surgery.

  • choriocarcinoma
  • hydatidiform mole
  • management
  • resistance

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