PT  - JOURNAL ARTICLE
AU  - Rita Mamede
AU  - Mariana Beja
AU  - Dusan Djokovic
AU  - Cristina Costa
TI  - Invasive mole presenting as a heavily bleeding vaginal lesion 3 weeks after uterine evacuation
AID  - 10.1136/bcr-2021-242208
DP  - 2021 Jun 01
TA  - BMJ Case Reports
PG  - e242208
VI  - 14
IP  - 6
4099  - http://casereports.bmj.com/content/14/6/e242208.short
4100  - http://casereports.bmj.com/content/14/6/e242208.full
SO  - BMJ Case Reports2021 Jun 01; 14
AB  - 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.