A Case of Refractory Gestational Trophoblastic Neoplasia requiring Hysterectomy after Methotrexate

However, increasing hCG levels two months after cessation of methotrexate led to concern for residual disease. As such, she was referred to our center for a second opinion. She was classified as FIGO stage I with a WHO score of 6 points, due to: time frame of 12 months since index pregnancy, baseline hCG and previous utilization of single drug (table 1). Her serum hCG increased to 110, leading to the resumption of MTX. She initially responded well to retreatment with MTX, demonstrating undetectable HCG levels for almost three months. After three months, her hCG again began to increase while on treatment (table 2). Possible treatment options at that point included actinomycin-D, EMA/CO, avelumab and radical hysterectomy. The patient had completed child bearing and elected to undergo a radical abdominal hysterectomybilateral salpingectomy. Post-surgical pathology ultimately demonstrated a gestational trophoblastic tumor, most consistent with choriocarcinoma invading into the myometrium. Her post-operative HCG was undetectable. INTRODUCTION