L. Carlini, A. Villa, L. Busci, L. Frigerio
Background: Persistent gestational trophoblastic disease (GTD) following partial molar pregnancy in the absence of metastasis is treated with single-agent chemotherapy, either Methotrexate or Dactinomycin. Pelvic hemorrhage from GTD is an important and great problem.
Surgical interventions are invasive and not preserving the fertility. In contrast, percutaneous transcatheter embolization represents an interesting alternative to operative intervention in women bleeding for symptomatic GTD. We report a case of GTD in which a selective uterine artery embolization achieved both the control of pelvic hemorrhage and of disease without chemotherapy with the complete normalization of BHCG levels. CASE A 30 year-old woman gravida 3, para 1 was undergone a uterine curettage for a spontaneous miscarriage.
Histopatologic examination revealed a partial hydatiform mole. The patient was followed weekly with a serum determination of BHCG. After 3 consecutive rising values (4166 mU/mL, 6500mU/mL, 11652,6 mU/mL) the diagnosis of GTD was made. Previous appropriate staging, the patient was designated as low-risk and should have treated with a single-agent chemotherapy.
Instead she was referred to our Dept for severe vaginal bleeding. After uterine tamponade without advantage, the patient underwent a selective uterine artery embolization with complete resolution of bleeding.
At the same time BHCG levels decreased until they were normal for 3 consecutive weeks, followed by monthly evaluations for twelve consecutive normal levels. She remains free from disease and wishes a new pregnancy. Conclusion: We conclude that angiographic embolization should be an effective and less invasive technique for the control of massive pelvic hemorrhage due to GTD and it could be a new approach for the treatment of this disease.