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


METHODS
A review of patients with vaginal metastases from GTN treated at a regional trophoblastic disease center from 1962 to 2006.


RESULTS
Vaginal metastases were present in 36 (4.5%) of the 804 patients treated for GTN. FIGO stage was II in 13 patients (36%), III in 22 patients (61%) and IV in 1 patient (3%). Twenty-three patients (65%) were low-risk by modified WHO criteria. The vaginal metastases were most frequently single lesions (61%) on the anterior vaginal wall (49%) with a histologic classification of choriocarcinoma (67%). Significant bleeding necessitated blood transfusion (median, 7 units; range, 1-26 units) in 13 patients (36%). Seven patients (19%) required 1 or more procedures for control of bleeding, including excision, suturing and/or hypogastric artery ligation/embolization. Twenty-three patients (64%) received single-agent chemotherapy with methotrexate and/or actinomycin-D, while 13 patients (36%) received multiagent chemotherapy regimens.


CONCLUSIONS
Overall, 29 (81%) of 36 patients with vaginal metastases were cured. Vaginal metastasis from GTN does not uniformly confer a worse prognosis or necessitate multiagent chemotherapy, although procedures for control of bleeding may be required.
Berry
Emily
E
John I. Brewer Trophoblastic Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Hagopian
George S
GS
Lurain
John R
JR
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000473:pathology* / Q000628:therapy*; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D014625:Vaginal Neoplasms / Q000556:secondary / Q000628:therapy*
D000970:Antineoplastic Agents