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Invasive mole presenting as a heavily bleeding vaginal lesion 3 weeks after uterine evacuation
  1. Rita Mamede1,
  2. Mariana Beja1,
  3. Dusan Djokovic1,2 and
  4. Cristina Costa1,2
  1. 1Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
  2. 2Obstetrics and Gynaecology Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
  1. Correspondence to Dr Rita Mamede; rmamede{at}chlo.min-saude.pt

Abstract

Gestational trophoblastic disease occurs in 1–3:1000 gestations worldwide. Up to one-fifth of complete hydatidiform moles undergo malignant transformation, with 2%–4% manifesting as metastatic disease. Of these, a third present with vaginal metastases, which can cause bleeding and discharge. We describe the case of a 49-year-old primiparous woman presenting with syncope and intense bleeding from an anterior vaginal lesion, 3 weeks after uterine evacuation for a presumed spontaneous abortion. A vaginal metastatic nodule was suspected; haemostasis was achieved with vaginal packing, precluding the need for surgical intervention. The patient was ultimately diagnosed with invasive mole with vaginal and lung metastases (stage III high-risk gestational trophoblastic neoplasia (GTN)) and started on multiple-agent chemotherapy. Two months later the lesion had regressed completely, and remission was reached 2 weeks later. Clinicians should consider the possibility of metastatic GTN with vaginal involvement whenever heavy vaginal bleeding follows a recent history of failed pregnancy.

  • gynaecological cancer
  • pregnancy

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Footnotes

  • Contributors CC identified the case and, together with MB, initially managed the patient. DD was involved in the staging and gynaecological follow-up of the patient, while Dr Adélia Félix, an Oncologist at our institution, defined the treatment plan and oversaw its implementation and follow-up. RM and CC had the idea to publish the case. RM performed the literature research and wrote the article; CC was a major contributor in revising the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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