title: A case of metastasizing invasive hydatidiform mole. Is less--less good? Review of the literature with regard to adequate treatment.
abstract: BACKGROUND
  Patients with invasive hydatidiform moles (IHM) have a good prognosis. Even if disease has spread, monocytostatic treatment might be sufficient if the diagnosis has been histologically confirmed. Established classifications divide gestational trophoblastic disease (GTD) including choriocarcinoma into cases with "high" and "low" risk. Without respect to histology "high-risk" cases are recommended to obtain polychemotherapy.
  
  
  METHODS
  A 40-year-old nullipara underwent hysterectomy for persistent vaginal bleeding after she had already been treated with curettage for hydatidiform mole. An IHM was pathohistologically confirmed. There were no signs of pulmonary spread or other metastases at the time of surgery. Postsurgically persistent beta-hCG levels lead to thorough staging, which revealed multiple pulmonary metastases and a vaginal metastasis. Despite metastasizing GTD with poor prognosis criteria she was treated with single agent therapy. Eight cycles of two weekly methotrexate (MTX) were administered. All sites of metastases responded and our patient is still fine after one year of follow-up.
  
  
  CONCLUSIONS
  With respect to this and other reports monochemotherapy can be a reasonable primary treatment for metastatic IHM.
authors.affiliation: Departament of Obstetrics and Gynecology, University of Wuerzburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Honig
authors.forename: L
authors.initials: L
authors.lastname: Rieger
authors.forename: P
authors.initials: P
authors.lastname: Kristen
authors.forename: M
authors.initials: M
authors.lastname: Eck
authors.forename: T
authors.initials: T
authors.lastname: Frambach
authors.forename: A
authors.initials: A
authors.lastname: Tschammler
authors.forename: H
authors.initials: H
authors.lastname: Caffier
authors.forename: J
authors.initials: J
authors.lastname: Dietl
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D002820:Hydatidiform Mole, Invasive / Q000556:secondary* / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary* / Q000628:therapy; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology* / Q000628:therapy; D014625:Vaginal Neoplasms / Q000556:secondary* / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents; D008727:Methotrexate