The Post-Molar Gestational Trophoblastic Neoplasia in a 25-Year-Old Woman
DOI:
https://doi.org/10.25077/aoj.9.2.288-297.2025Abstract
Introduction: Hydatidiform mole is the most common gestational trophoblastic disease in regions such as Asia, Africa, and Latin America, with a lower incidence in European countries. In Indonesia, the incidence ranges from 1 in 100 to 141 pregnancies, particularly affecting women under 20 and over 45 years old, often in those with low socio-economic status and nutritional deficiencies (such as protein, folic acid, and carotene).
Case Presentation: A 25-year-old female presented to Malang City General Hospital with complaints of recurring brownish-black foamy vaginal discharge, nausea-vomiting for two months. She had regular menstrual cycles and no contraception use. On examination, the uterine fundal height was one finger above the symphysis pubis with no fetal heart sounds or uterine contractions. Vaginal examination revealed a closed cervix and foamy black blood. Ultrasound showed a retroverted uterus, a 6.4 mm gestational sac without a fetal pole, 37.0×31.6mm residual tissue, a honeycomb pattern, and no myometrial invasion. Blunt curettage removed 30 grams of bubble-like tissue. Histopathology confirmed a complete hydatidiform mole. β-hCG levels and uterine size continued rising post-curettage.
Discussion: A significant number of low-risk PGTN patients with a FIGO score of 0-6 show a complete response to first-line methotrexate/folinic acid therapy. However, those with a score of 6 or β-hCG levels >100,000 IU/l have a higher resistance rate. Despite this, the survival rate remains very high.
Conclusion: PGTN is a malignant uterine tumor linked to molar pregnancies. Single-agent chemotherapy remains the standard treatment and has a generally favorable prognosis.
References
1. Noer Islami, I. P. (2020) ‘Faktor Risiko Kejadian Tumor Trofoblas Gestasional Pasca Evakuasi Molahidatidosa di RSUP Dr. Hasan Sadikin Bandung Periode Agustus 2013 – Agustus 2018’, Indonesian Journal of Obstetrics & Gynecology Science, 3(2), pp. 106–112. doi: 10.24198/obgynia.v3n2.201.
2. Lund, H., Vyberg, M., Eriksen, H.H. et al. Decreasing incidence of registered hydatidiform moles in Denmark 1999–2014. Sci Rep 10, 17041 (2020). https://doi.org/10.1038/s41598-020-73921-4
3. Sanif, Rizal. Gestational Tropjhoblastic Disease. Conference of Medical Sciences Dies Natalis Faculty of Medicine Universitas Sriwijaya Medical and Health Education During the COVID-19 Pandemic: Challenges and Innovation Volume 3, No 1, tahun 2021
4. Ghassemzadeh S, Farci F, Kang M. Hydatidiform Mole. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459155/
5. Soper JT. Gestational Trophoblastic Disease: Current Evaluation and Management. Obstet Gynecol. 2021 Feb 1;137(2):355-370. doi: 10.1097/AOG.0000000000004240. Erratum in: Obstet Gynecol. 2022 Jan 1;139(1):149. doi: 10.1097/AOG.0000000000004589. PMID: 33416290; PMCID: PMC7813445.
6. Nasution, R. A. ., Algifari, M. Z., & Zulfadli, Z. (2024). Age Greater than 40 Years Old as Hydatidiform Mole Risk Factor: a Case Report. Medical Profession Journal of Lampung, 14(6), 1185-1189. https://doi.org/10.53089/medula.v14i6.1150
7. Budiana, I. N. G. S. (2015) ‘Pendidikan Kedokteran Berkelanjutan Obstetri Dan Ginekologi Ke-7’, in Pkb Obstetri Dan Ginekologi Ke-7. Denpasar: SMF Obstetri dan Ginekologi FK UNUD RSUP Sanglah, pp. 129–144.
8. Djuwantono, T. (2015) Prosiding Kongres Obstetri dan Ginekologi indonesia XVI Bandung. Bandung: Dep./SMF Obstetri dan Ginekologi Fakultas Kedokteran Unpad RSUPDr. Hasan Sadikin Bandung - Bekerja sama dengan POGI
9. Pedoman Nasional Pelayanan Kedokteran Kanker Ginekologi. HOGI. 2018. Tumor Trofoblas Gestasional. Hal. 1-73
10. Leonoor, Coopmans., Brenna, Swift., Chris, Coyle., Xianne, Aguiar., Naveed, Sarwar., Kamaljit, Singh., Matthew, Winter., Michael, J, Seckl. (2023). 2. #248 How long do we need to monitor HCG after evacuation of a complete hydatidiform mole?. doi: 10.1136/ijgc-2023-esgo.50
11. Roya, Riahi., Abbas, Rahimiforoushani., Keramat, Nourijelyani., Nooshin, Akbari, Sharak., Mahmood, Bakhtiyari. (2020). 3. Early Detection of Gestational Trophoblastic Neoplasia Based on Serial Measurement of Human Chorionic Gonadotrophin Hormone in Women with Molar Pregnancy.. International Journal of Preventive Medicine, doi: 10.4103/IJPVM.IJPVM_288_19
12. Joyce CM, Fitzgerald B, McCarthy TV, Coulter J, O'Donoghue K. Advances in the diagnosis and early management of gestational trophoblastic disease. BMJ Med. 2022 Dec 16;1(1):e000321. doi: 10.1136/bmjmed-2022-000321. PMID: 36936581; PMCID: PMC9978730.
13. Eiriksson L, Dean E, Sebastianelli A, Salvador S, Comeau R, Jang JH, et al. Guideline no. 408: management of gestational trophoblastic diseases. J Obstet Gynaecol Can (2021) 43(1):91–105. doi: 10.1016/j.jogc.2020.03.001
14. Prabhu IK, Rosenbaum A. Hydatidiform Mole in a Patient With a Concern for Neoplasia: A Case Report. Cureus. 2020 Sep 8;12(9):e10319. doi: 10.7759/cureus.10319. PMID: 33052280; PMCID: PMC7544604.
15. Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, Lurain JR, Massuger L. Diagnosis and management of gestational trophoblastic disease: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(Suppl 1):86-93. doi: 10.1002/ijgo.13877. PMID: 34669197; PMCID: PMC9298230.
16. Fei, Wang., Zihe, Wang., Xuelu, Ding., Hua-Jun, Yang., Ye, Guo., Hao, Su., Xirun, Wan., Li, juan, Wang., Xiang-Yang, Jiang., Yan, Xu., Feng, Chen., Wei, Cui., Fengzhi, Feng. (2022). 2. Combining serum peptide signatures with International Federation of Gynecology and Obstetrics (FIGO) risk score to predict the outcomes of patients with gestational trophoblastic neoplasia (GTN) after first-line chemotherapy. Frontiers in Oncology, doi: 10.3389/fonc.2022.982806
17. Mousavi Seresht L, Farazestanian M, Yousefi Z. Single-agent chemotherapy in low-risk gestational trophoblastic neoplasia. Caspian J Intern Med. 2023 Winter;14(1):108-111. doi: 10.22088/cjim.14.1.108. PMID: 36741498; PMCID: PMC9878903.
18. Shahzadi, M., Khan, S.R., Tariq, M. et al. Review of current literature on gestational trophoblastic neoplasia. J Egypt Natl Canc Inst 35, 37 (2023). https://doi.org/10.1186/s43046-023-00195-y
19. Braga A, Mora P, de Melo AC, Nogueira-Rodrigues A, Amim-Junior J, Rezende-Filho J, Seckl MJ. Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide. World J Clin Oncol. 2019 Feb 24;10(2):28-37. doi: 10.5306/wjco.v10.i2.28. PMID: 30815369; PMCID: PMC6390119.
20. Linjuan, Xu., Min, Feng., Jing, Cai., Hongmei, Li. (2022). 3. Case report: Conservative treatment for fertility preservation in a woman with hemoperitoneum due to an invasive mole. Frontiers in Oncology, doi: 10.3389/fonc.2022.1019082
21. Joneborg U, Coopmans L, van Trommel N, et al. Fertility and pregnancy outcome in gestational trophoblastic disease International Journal of Gynecologic Cancer. British Medical Journal. 2021;31:399-411.
22. Ayatollahi, H. , & Jahangard, S. (2021). Gestational Trophoblastic Neoplasia with Brain Metastasis Presented with Initial Presentation of Dyspnea: A Case Report. Journal of Obstetrics, Gynecology and Cancer Research, 6(1), 35-41. doi: 10.30699/jogcr.6.1.35
23. Zong L, Yang J, Wang X, Kong Y, Ren T, Zhao J, Feng F, Wan X, Xiang Y. Management and prognosis of patients with liver metastases from gestational trophoblastic neoplasia: a retrospective cohort study. Cancer Manag Res. 2018 Mar 23;10:557-563. doi: 10.2147/CMAR.S160606. PMID: 29606889; PMCID: PMC5868620.
24. Zhang T, Guo Y, He X, et al. Effect of lung metastasis on the treatment and prognosis of patients with gestational trophoblastic neoplasia: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2024; 103: 636-644. doi:10.1111/aogs.14789
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