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Year : 2022  |  Volume : 46  |  Issue : 4  |  Page : 177-181

Primary vaginal gestational trophoblastic neoplasia treated with uterine angiographic embolization and Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine: Philippines' first reported case

Department of Obstetrics and Gynecology, St. Luke's Medical Center, Quezon City, Philippines

Correspondence Address:
Maria Concepcion D. Cenizal-Santos
Doble Cenizal-Santos, 181 Cordillera Street, Quezon City 1114
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/pjog.pjog_34_22

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Gestational trophoblastic neoplasia (GTN) in itself is an uncommon condition, much so is primary extrauterine GTN. The incidence of GTN in the Philippines is at 22.4/40,000 pregnancies. However, no report has been made for primary extrauterine GTN. Only two cases of primary vaginal choriocarcinoma are reported in literature. This is a case of a 26 year old G1P0 (0010) who came in for profuse vaginal bleeding. Serum beta-human chorionic gonadotropin (β-hCG) was elevated and ultrasound showed hypervascular vaginal mass and an empty uterus. A primary vaginal GTN was considered and the patient was treated with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMACO) regimen. During the course of chemotherapy, there was a note of profuse vaginal bleeding which was controlled by angiographic uterine artery embolization. A normal β-hCG level was achieved after six cycles of EMACO. The patient was able to have three successful pregnancy outcomes thereafter. Primary vaginal GTN is a rare condition that requires a high index of suspicion. In a nulliparous patient complicated with profuse vaginal bleeding, angiographic embolization is an effective fertility-sparing procedure that can manage the said complication.

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