Recurrent gestational trophoblastic disease in a case of suspected quiescent gestational trophoblastic disease: a...

In Japan there are no reported cases of phantom human chorionic gonadotropin (hCG) or quiescent gestational trophoblastic disease (GTD). GTD is managed well in Japan according to Japanese guidelines for the treatment of GTD, and we have almost conquered this disease during recent decades. Furthermore, the incidence of GTD is decreased today, associated with the decrease of birth rate in Japan. Many young doctors now have little opportunity to see typical classic mole and participate in the management of GTD during their residency training. This case is the first case of suspected quiescent GTD in Japan and was referred to us for further evaluation. After careful evaluation, including measurement of hyperglycosylated hCG, we concluded that this case was not a quiescent GTD but recurrent GTD.

The patient was a 46-year-old woman, G3, P2, A1, who underwent dilation and curettage for complete mole 7 years earlier. hCG elevated during follow-up, and a 50-mg methotrexate single injection was given. hCG decreased to 20-30 mIU/mL, but it then plateaued for 3 months. Etoposide 100 mg/m2/day was then given for 5 days, and hCG became undetectable. Three years and 3 months later beta-hCG went up to 3.1 ng/mL, but magnetic resonance imaging and computed tomography scans did not show any evidence of tumor. The patient was referred to us as a case of suspected quiescent GTD for further evaluation.

After thorough evaluation we concluded that this case was not a quiescent GTD but a recurrent GTD. We emphasize that sufficient initial chemotherapy is very important to reduce the risk of recurrence.