Gestational trophoblastic disease: the significance of vaginal metastases

Purpose: To evaluate patients with vaginal lesions in gestational trophobla stic disease and determine prognostic and therapeutic implications applicab le to management. Methods: Twelve patients among 75 cases of gestational trophoblastic neopla sia 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 patie nts presented initially with hemorrhage and bloody leukorrhea, the remainin g 2 were diagnosed during a routine study of hydatidiform mole. The sires o f involvement were almost always the anterior distal vaginal wall. Five cas es had additional lung and 1 case had lung, liver, spleen and brain metasta ses. 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. Conclusion: The presence of large vaginal metastases should be classified a s a high-risk factor and these patients must be treated by multiple agent c hemotherapy.