Uterine Rescue in High-Risk Gestational Trophoblastic Neoplasia Treated with EMA-CO by Uterine Arteries Embolization due to Arteriovenous Malformations

被引:2
|
作者
Belo da Silva, Arlley Cleverson [1 ]
Passos, Jurandir Piassi [1 ]
Signorini Filho, Roney Cesar [1 ]
Braga, Antonio [2 ]
Mattar, Rosiane [1 ]
Sun, Sue Yazaki [1 ]
机构
[1] Univ Fed Sao Paulo, Dept Obstet, Escola Paulista Med, Sao Paulo, SP, Brazil
[2] Univ Fed Rio de Janeiro, Matern Sch, Rio De Janeiro, RJ, Brazil
来源
关键词
gestational trophoblastic disease; gestational trophoblastic neoplasia; EMA-CO protocol; uterine artery embolization; high-risk pregnancy; HYDATIDIFORM MOLE; DISEASE; DIAGNOSIS; OUTCOMES;
D O I
10.1055/s-0041-1725054
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Complete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation. We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doencas Trofoblasticas do Hospital Sao Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral artery puncture, which was crucial to avoid the hysterectomy and allow GTN cure and maintenance of reproductive life.
引用
收藏
页码:323 / 328
页数:6
相关论文
共 23 条
  • [1] Primary treatment of metastatic high-risk gestational trophoblastic neoplasia with EMA-CO chemotherapy
    Lurain, John R.
    Singh, Diljeet K.
    Schink, Julian C.
    [J]. JOURNAL OF REPRODUCTIVE MEDICINE, 2006, 51 (10) : 767 - 772
  • [2] Impact of consolidation cycles in predicting recurrence in patients treated with EMA-CO for high-risk gestational trophoblastic neoplasia
    Deleuze, A.
    Hajri, T.
    Bolze, P. A.
    Rouge, T. De La Motte
    [J]. ANNALS OF ONCOLOGY, 2023, 34 : S534 - S534
  • [3] EMA-CO chemotherapy for high-risk gestational trophoblastic neoplasia: a clinical analysis of 54 patients
    Lu, W. -G.
    Ye, F.
    Shen, Y. -M.
    Fu, Y. -F.
    Chen, H. -Z.
    Wan, X. -Y.
    Xie, X.
    [J]. INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, 2008, 18 (02) : 357 - 362
  • [4] The use of EMA-CO in high-risk gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience
    Ghosh, S.
    Baron, E.
    Nevadunsky, N.
    Goldstein, D.
    Horowitz, N.
    Berkowitz, R.
    [J]. GYNECOLOGIC ONCOLOGY, 2010, 116 (03) : S91 - S92
  • [5] Spontaneous Uterine Rupture of a High-Risk Gestational Trophoblastic Neoplasia
    Alkhanbouli, Maryam
    Hana, Tommy
    Laframboise, Stephane
    Bouchard-Fortier, Genevieve
    [J]. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA, 2024, 46 (07)
  • [6] Uterine arteriovenous malformations following gestational trophoblastic neoplasia: a systematic review
    Touhami, Omar
    Gregoire, Jean
    Noel, Patricia
    Trinh, Xuan Bich
    Plante, Marie
    [J]. EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, 2014, 181 : 54 - 59
  • [7] High-Risk Metastatic Gestational Trophoblastic Neoplasia Primary Management with EMA-CO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine) Chemotherapy
    Cagayan, Ma. Stephanie Fay S.
    [J]. JOURNAL OF REPRODUCTIVE MEDICINE, 2012, 57 (5-6) : 231 - 236
  • [8] Embolization of bleeding residual uterine vascular malformations in patients with treated gestational trophoblastic tumors
    Lim, AKP
    Agarawal, R
    Seckl, MJ
    Newlands, ES
    Barrett, NK
    Mitchell, AWM
    [J]. RADIOLOGY, 2002, 222 (03) : 640 - 644
  • [9] EMA/CO REGIMEN IN HIGH-RISK GESTATIONAL TROPHOBLASTIC TUMOR (GTT)
    BOLIS, G
    BONAZZI, C
    LANDONI, F
    MANGILI, G
    VERGADORO, F
    ZANABONI, F
    MANGIONI, C
    [J]. GYNECOLOGIC ONCOLOGY, 1988, 31 (03) : 439 - 444
  • [10] WEEKLY EMA CO CHEMOTHERAPY FOR HIGH-RISK GESTATIONAL TROPHOBLASTIC TUMORS (GTTS)
    NEWLANDS, ES
    RUSTIN, GJS
    BAGSHAWE, KD
    BEGENT, RHJ
    HOLDEN, L
    [J]. BRITISH JOURNAL OF CANCER, 1986, 54 (01) : 202 - 202