Spontaneous Regression Of Quiescent Gestational Trophoblastic Disease After Pregnancy: A Case Report
Okada, Y., Miyamoto, S., Mimura, T., Ishikawa, T., Sekizawa, A., & Matsumoto, K. (2019). Spontaneous regression of quiescent gestational trophoblastic disease after pregnancy: a case report. BMC women's health, 19(1), 101. https://doi.org/10.1186/s12905-019-0794-2
View Original Source →Abstract
BACKGROUND: A persistent low-level elevation of serum human chorionic gonadotropin (hCG) without clinical or radiological evidence of pregnancy or tumors was recently defined as quiescent gestational trophoblastic disease (Q-GTD). Whether patients with Q-GTD should be treated or allowed to become pregnant remains unclear. We herein report a rare case of Q-GTD in which the hCG level spontaneously returned to normal after a successful pregnancy. CASE PRESENTATION: The patient was a 37-year-old primigravida who presented with a persistent low-level elevation of hCG after uterine evacuation of a hydatidiform mole. There was no evidence of neoplasia in the uterus or distant metastasis. The low-level elevation of hCG persisted for at least 2 years but never exceeded 200 mIU/mL. The patient had a successful pregnancy at the age of 40 years. CONCLUSIONS: Interestingly, her hCG level subsequently normalized without chemotherapy. The present case may imply the safety and therapeutic effect of pregnancy in women with Q-GTD.
Case Details
Disease Location
Uterus
Personal Characteristics
A 37-year-old primigravida
Clinical Characteristics
Referred because of a diagnosis of a hydatidiform mole at 10 weeks of gestation. Her serum hcg level was 35,000 miu/ml, and transvaginal ultrasound demonstrated an abnormal mass of 65 × 38 mm with a specific “snow-storm” pattern in the uterine cavity. Pathological diagnosis was a complete hydatidiform mole. The serum hcg level decreased to within the normal range temporarily after molar evacuation, but it gradually increased again at 40 weeks after evacuation. The serum hcg level persisted in the range of 5 to 50 miu/ml without response to oral contraceptives. These evaluations led to a diagnosis of quiescent gestational trophoblastic disease (q-gtd). After 2 years she was conceived naturally and had an uneventful and successful delivery. The placenta appeared macroscopically normal.
Remission Characteristics
Her hcg level returned to normal 2 months after delivery
Treatment & Mechanisms
Clinical Treatment
Curettage
Non-Clinical Treatment
None reported