Persistence of gestational trophoblastic disease for longer than 1 year following evacuation of hydatidiform mole.
BACKGROUND
A spontaneous fall in the radioimmunoassay for the beta subunit of hCG to less than 2 mIU/mL documents regression of hydatidiform mole following evacuation of a molar pregnancy. Continued negative hCG levels for the year after evacuation indicates the absence of risk for persistent gestational trophoblastic disease. This report describes an unusual case of recurrent nonmetastatic gestational trophoblastic disease 16 months after initial evacuation.


METHODS
A 29-year-old woman presented at 19 weeks' gestation with severe preeclampsia and vaginal bleeding. Pelvic ultrasonography demonstrated a molar pregnancy. Pathology following uterine evacuation confirmed a hydatidiform mole. Serial hCG levels fell progressively to less than 2 mIU/mL over the following 25 weeks. She remained compliant with oral contraceptive pills despite having no sexual activity. Sixteen months after uterine evacuation, recurrence of gestational trophoblastic disease was documented by a rising beta-hCG, negative pelvic ultrasound, normal liver function tests, and normal computed tomography of the head. Endometrial curettage showed no chorionic villi or molar tissue. She was treated with five courses of actinomycin D and has remained disease-free for the following 5 years.


CONCLUSIONS
This late recurrence of gestational trophoblastic disease suggests that those with a molar pregnancy may benefit from surveillance beyond 1 year after uterine evacuation.
Elmer
D B
DB
Department of Obstetrics and Gynecology, New England Medical Center, Boston, Massachusetts.
Granai
C O
CO
Ball
H G
HG
Curry
S L
SL
D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human; D003609:Dactinomycin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010446:Peptide Fragments / Q000097:blood; D011247:Pregnancy; D013997:Time Factors; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014619:Vacuum Curettage
D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments; D003609:Dactinomycin