title: Gestational trophoblastic disease: the significance of vaginal metastases.
abstract: OBJECTIVE
  To evaluate patients with vaginal lesions in gestational trophoblastic disease and determine prognostic and therapeutic implications applicable to management.
  
  
  METHODS
  Twelve patients among 75 cases of gestational trophoblastic neoplasia were analyzed retrospectively between 1990 and 1997. Vaginal metastases were documented by physical examination and biopsy. Two patients received MAC III regimen (5 and 7 courses), 4 patients received EMA-CO regimen for 2 to 11 courses, while 6 were administered methotrexate alone. Remission was defined as 3 weekly beta hCG levels below assay sensitivity (<5 mIU/ml).
  
  
  RESULTS
  The mean age of the patients was 25.4 years. While 10 of the patients presented initially with hemorrhage and bloody leukorrhea, the remaining 2 were diagnosed during a routine study of hydatidiform mole. The sites of involvement were almost always the anterior distal vaginal wall. Five cases had additional lung and 1 case had lung, liver, spleen and brain metastases. Three of the patients who received methotrexate as monotherapy did not respond to therapy and were switched to EMA-CO. Overall survival was 91.6%. One patient died in the first month of the initial therapy.
  
  
  CONCLUSIONS
  The presence of large vaginal metastases should be classified as a high-risk factor and these patients must be treated by multiple agent chemotherapy.
authors.affiliation: Department of Obstetrics and Gynecology, Cukurova University, Faculty of Medicine Balcali, Adana, Turkey.
authors.forename: M A
authors.initials: MA
authors.lastname: Vardar
authors.forename: A
authors.initials: A
authors.lastname: Altintaş
authors.forename: S C
authors.initials: SC
authors.lastname: Demir
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014328:Trophoblastic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D014625:Vaginal Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000556:secondary*