Management of gestational trophoblastic neoplasia with vaginal metastasis

A patient who had gestational trophoblastic neoplasia (GTN) with vaginal metastasis resistant to sequential methotrexatefolinic acid (MTX-FA) treatment is presented. She was 25 years old and presented with vaginal bleeding. A curettage was performed and the pathology revealed a partial hydatidiform mole. There was a rise in β-hCG, a 2 cm metastatic lesion on the middle third of the right wall of the vagina, and there were nodular implants up to a size of 12 mm in both lungs. Therefore, she was diagnosed as having a GTN. She was considered as having low risk metastatic GTN, as her modified WHO score was 3. She took seven cycles of sequential MTX-FA theraphy. She was accepted as resistant to MTX-FA and her treatment was changed to actinoycin-D, because her β-hCG values plateaued. Her β-hCG was normalized after the second cycle of actinoycin-D. She took 2 additional cycles of actinoycin-D. Resistance to MTXFA may develop in patients who had a GTN with vaginal metastasis, even though they have low risk scores. These patients may respond to actinoycin-D.