Primary vaginal gestational trophoblastic neoplasia treated with uterine angiographic embolization and chemotherapy / Philippine Journal of Obstetrics and Gynecology

ABSTRACT

@#Gestational trophoblastic neoplasia (GTN) in itself is an uncommon condition, much so is a primary extrauterine GTN. The incidence of GTN in the Philippines is at 22.4/40,000 pregnancies. However, no report has been made for primary extrauterine GTN. Only two cases of primary vaginal choriocarcinoma are reported in the literature. This is a case of a 26‑year‑old gravida 1 para 0 (0010) who came in for profuse vaginal bleeding. Serum beta‑human chorionic gonadotropin (β‑hCG) was elevated and ultrasound showed a hypervascular vaginal mass and an empty uterus. A primary vaginal GTN was considered, and the patient was treated with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMACO) regimen. During the course of chemotherapy, there was a note of profuse vaginal bleeding, which was controlled by angiographic uterine artery embolization. A normal β‑hCG level was achieved after six cycles of EMACO. The patient was able to have three successful pregnancy outcomes thereafter. Primary vaginal GTN is a rare condition that requires a high index of suspicion. In a nulliparous patient complicated with profuse vaginal bleeding, angiographic embolization is an effective fertility‑sparing procedure that can manage the said complication.