Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2018

Primary vaginal gestational trophoblastic neoplasia treated with uterine angioprahic embolization and chemotherapy  (#45)

Maria Concepcion Cenizal 1 , Angelica Anne Chua 1 , Leo Francis Aquilizan 1
  1. Department of Obstetrics and Gynecology, Quezon City, NATIONAL CAPITAL REGION, Philippines

Gestational trophoblastic neoplasia, in general, is a rare condition, much so is primary extrauterine gestational trophoblastic neoplasia. In the Philippines, local data showed that incidence of gestational trophoblastic neoplasia remained to be almost constant at 22.4 per 40,000 pregnancies. However, the incidence of primary extrauterine gestational trophoblastic neoplasia was not mentioned. To date, there are only  2 cases of primary vaginal choriocarcinoma and 1 case of primary vulvar choriocarcinoma reported in the literature. This is a case of a 26-year old gravida 1 para 0 (0-0-1-0) who came in for profuse vaginal bleeding. Serum beta human chorionic gonadotropin (BhCG) was elevated and the ultrasonographic study showed a hypervascular vaginal mass and an empty uterus. The patient was diagnosed with primary vaginal gestational trophoblastic neoplasia and was started with combination chemotherapy of Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine (EMACO). However, during the course of chemotherapy, profuse vaginal bleeding was noted which was controlled by angiographic embolization of the uterine arteries. The patient tolerated the procedure and achieved a normal BhCG level after six cycles of  EMACO. Primary vaginal gestational trophoblastic neoplasia is a rare condition that warrants a high index of suspicion. Combination chemotherapy with EMACO is the cornerstone of treatment.  Angiographic embolization is a minimally invasive procedure that is safe and effective in managing acute hemorrhage among patients with gestational trophoblastic neoplasia.