Introduction/Background Gestational trophoblastic neoplasia comprises a unique group of human neoplastic diseases that derive from fetal trophoblastic tissues. The hydatidiform mole is the most common form of GTD, representing 80% of cases. An invasive mole is a hydatidiform mole characterized by the enlarged hydropic villi invading into the myometrium, into vascular spaces, or into extrauterine sites.

Results our patient wasG4 woman with a history of molar pregnancy 10 years ago which was treated with actinomycin due to the rise of hCG .At that time (10 YEARS AGO) she followed with BhCG and achieved normal pregnancy after that. (Her last child is 7 y old)

She was admitted with dyspnea (RR=35) and history of covid in 2 months later in the emergency department.

The chest CT image revealed extensive metastatic lung lesion .

Incredibly and unfortunately the pulmonologist took a biopsy without suspicion to GTN.

We requested BhCG which was 700.000 (IU) and vaginal metastasis in gynecologic exam

We put her on two courses Etoposide/Cisplatin and then(with relative response) 7 courses EMA-CO as GTN with lung & vaginal metastasis .(stage 3, Score 16)

She had a good response to chemotherapy.

In the last 3 courses the BhCG remained plato ( 20 IU) therefore the tumor Board plan was hysterectomy for the patient.

Conclusion She recieved 3 cycles EMA_EP and BhCG was negative for 6 months.

Disclosures There is no conflict of interest