Gestational Trophoblastic Disease Metastasized to the Vagina: Case Report

Abstract

Background: Gestational trophoblastic disease is caused by placenta abnormalities and can metastasize in several places outside the uterus, including the vagina. Its criteria are based on physical examination, laboratory examination, ultrasonography, and histopathology. In addition, the malignancy classification is based on FIGO 2000. Treatment is then carried out according to the malignancy level, and monitoring of results can be carried out based on the β-hCG measurement.

Case illustration: A 38-year-old multiparous patient with a gestational age of 12 weeks based on HPHT experienced bleeding in the last three hours before admission to the hospital, originating from a 4 x 4 cm vaginal mass detected in the lower 1/3 of the vagina and active bleeding. Ultrasound examination of the whole abdomen showed that the uterus was enlarged and anteflexed with a uterine size of 18x20 cm according to the gestational age of 20 weeks; a multilocular cystic mass appeared in the adnexa area with the impression of a lutein cyst measuring 3x3 cm; a heterogeneous mass appeared in the uterine cavity with multiple anechoic areas giving a Honeycomb appearance; no gestational sac was seen, and the myometrium was intact. Also, the examination of β-HCG levels was found to be more than 1,000,000 mIU/mL. Based on the presence of a vaginal mass suspected of being metastatic from the uterus, a WHO scoring was performed, and a score of 7 was obtained so that it was included in the high-risk category.

Conclusion: Diagnosis and classification of gestational trophoblastic disease help determine appropriate management, thereby increasing patient treatment success.