Vaginal metastases complicating gestational trophoblastic neoplasia

To evaluate the clinical experience and outcomes of patients with gestational trophoblastic neoplasia (GTN) complicated by vaginal metastases.

A retrospective descriptive study of patients with vaginal metastases from GTN treated at the University of the Philippines-Philippine General Hospital (UP-PGH) Trophoblastic Disease Section from 1998 to 2008.

Vaginal metastases were present in 46 (11%) of the 424 patients treated for GTN. The majority of the patients (69.6%) were stage III, 19.6% were stage II and 10.9% were stage IV. Thirty-six patients (78.3%) were high-risk patients with World Health Organization scores of > 7. Eleven patients (24%) had bleeding vaginal lesions on initial consultation, and transfusion of packed red blood cells was necessary in all of these patients. Interventions to control bleeding included vaginal packing with methotrexate solution (5/11 or 46%), ligation of bleeders with bilateral internal iliac artery ligation (4/11 or 36%), over sewing of bleeding vaginal lesions (2/11 or 18%), ligation of vaginal bleeders (3/11 or 27%), vaginal packing only (6/11 or 54%), methotrexate infiltration of vaginal mass (1/11 or 9%) and external beam radiation (1/11 or 9%). Of the 37 patients who were given chemotherapy, 26 (70%) had complete remission.

Prognosis with vaginal metastasis mainly depends on disease extent. Favorable response to chemotherapy was observed in low-risk patients with pretreatment hCG of < 100,000 mIU/mL and metastases confined to the vagina and/or pelvic area only.