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Identification and treatment of gestational trophoblastic neoplasia located in the cesarean scar
Author(s) -
Wang Xiaoyu,
Li Yuan,
Yang Junjun,
He Yonglan,
Wang Ming,
Wan Xirun,
Xiang Yang
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12417
Subject(s) - medicine , hysterectomy , pregnancy , lesion , chemotherapy , surgery , gestational trophoblastic neoplasia , human chorionic gonadotropin , retrospective cohort study , gestational age , gestational trophoblastic disease , obstetrics , gestation , genetics , hormone , biology
Objective To identify the clinical characteristics of, and the diagnostic and therapeutic strategies for, gestational trophoblastic neoplasia ( GTN ) located in the cesarean scar. Methods The present retrospective analysis was conducted among patients diagnosed with GTN located in the cesarean scar at Peking Union Medical College Hospital, Beijing, China, between June 1, 2006, and May 31, 2016. Clinical features, diagnostic and therapeutic procedures, and outcomes were reviewed. Results Of 938 women diagnosed with GTN , 31 (3.3%) patients had GTN located in the cesarean scar. Irregular vaginal bleeding was the main clinical manifestation. Twenty (65%) patients received an accurate diagnosis based on a history of molar pregnancy/a high β‐human chorionic gonadotropin level/typical imaging presentations. The remaining 11 patients were initially misdiagnosed; the definitive diagnosis was made by pathology. All patients received chemotherapy; 22 (71%) women also underwent hysterectomy or localized uterine lesion resection because of chemoresistant lesions. All patients had a complete remission; at a median follow‐up of 35 months, only 1 (3%) woman had a relapse. Conclusion Owing to its rarity and nonspecific symptoms, GTN located in the cesarean scar is prone to misdiagnosis. In patients without typical manifestations, the definitive diagnosis often relies on pathology. For treatment, uterine lesion resection is a useful adjunct to chemotherapy.