Gestational Trophoblastic Neoplasia in Perimenopausal Women: Clinical Analysis, Case Series, and Literature Review

Summary

Gestational trophoblastic neoplasia (GTN) is a rare invasive placental malignancy in perimenopausal women that is easily confused with abnormal vaginal bleeding. This article analyzes five cases (three choriocarcinomas and two invasive hydatidiform moles) to clarify diagnosis and treatment for clinical reference.

Abstract

Most gestational trophoblastic neoplasia (GTN) occurs in women of reproductive age, and its occurrence in perimenopausal women is extremely rare. A key symptom of GTN is vaginal bleeding, which can be difficult to distinguish from abnormal uterine bleeding commonly seen during perimenopause, making diagnosis in this population particularly challenging. This study retrospectively analyzed five cases of perimenopausal women diagnosed with GTN at the Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, between June 2013 and June 2023, including three cases of choriocarcinoma and two cases of invasive mole. The clinical features (age, parity, pregnancy history, main symptoms), diagnostic indicators (serum β-hCG levels, transvaginal ultrasound findings, pathological results), treatment protocols (surgical procedures, chemotherapy regimens), and follow-up outcomes were analyzed. The goal of this report is to provide a standardized clinical reference for the diagnosis and treatment of GTN in perimenopausal women, improve the accuracy of differential diagnosis, optimize treatment strategies, and enhance patient outcomes. All five patients completed treatment and follow-up (up to 2 years), with no recurrence observed. The results suggest that for perimenopausal women presenting with abnormal vaginal bleeding, combining serum β-hCG testing with pelvic imaging is crucial for early diagnosis. For patients without fertility requirements, comprehensive treatment with surgery (total hysterectomy plus bilateral adnexectomy) and chemotherapy may reduce chemotherapy dosage and improve treatment efficacy. This case series provides practical guidance for managing the diagnostic and therapeutic challenges of GTN in perimenopausal women.

Introduction

Gravid trophocyte disease, also known as gestational trophoblastic disease (GTD), is a collective term for placental trophocyte abnormalities caused by abnormal fertilization. It includes benign hydatidiform mole and malignant gestational trophoblastic neoplasia (GTN)¹. Hydatidiform mole is divided into complete and partial forms, while GTN includes invasive mole (IM), choriocarcinoma (CC), placental site trophoblastic tumor (PSTT), epithelioid trophoblastic tumor (ETT), and atypical placental site nodules². Among these, invasive mole (IM) and choriocarcinoma (CC) are the most common types of GTN.

Protocol

The operation followed standard procedures and received ethics approval (2024-P2-537) from the Ethics Committee of Beijing Friendship Hospital, Capital Medical University. Informed written consent was obtained from the patient. The study was conducted in accordance with institutional ethical standards. The reagents and equipment used in the study are listed in the Table of Materials.

1. Preoperative preparation

1. Bowel and fasting preparation
   1. One day before surgery, the patient was instructed to take oral sodium phosphate salt (concentration: 45 mL/bottle, dosage: two bottles, taken at....

Results

The surgical characteristics and perioperative outcomes of all five patients are summarized in Table 1.

Case 1 (Choriocarcinoma)
Treatment process:
The patient received two courses of chemotherapy before surgery using 5-fluorouracil (5-FU, 28 mg∙kg^-1∙day^-1, IV infusion for 8 days) and actinomycin D (ACT-D, 6 µg∙kg^-1∙day^-1, IV infusion for 8 days). After each course, serum β-hCG levels decline.......

Discussion

Gestational trophoblastic neoplasia (GTN) results from abnormal fertilization. In 1984, Davis et al. identified Y chromosome material in 9% of hydatidiform mole cases, 50% of invasive mole cases, and 74% of choriocarcinoma cases, suggesting that overexpression of paternal genes may contribute to malignant transformation⁵. Additional genetic alterations have also been implicated in GTN development⁶. GTN is rare, accounting for less than 1% of all female reproductive tract tu.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
5-fluorouracil	Tianjin Jinhui Pharmaceutical Co., Ltd.	H12020959
Ablation electrode	Tangshan Tianen Technology Co., Ltd.	(01) 06959137400020	sterile,single-use
Calcium Folinate Injection	Jiangsu Hengrui Medicine	H20000584
CT Scanner	GE/Canon	TSX-301C/0103300063	stable
Dactinomycin for Injection	Hanhui Pharmacerutical Co.,Ltd	H20023504
Fentanyl Citrate Injection	Yichang Renfu	H2003688
Medical gauze pad	Zhen De Medical Supplies Co., Ltd.		sterile,single-use
Methotrexate	Pfizer (Perth) Pty Limited	HJ20140207
One-time use precision filtration infusion set	Bayer Medical (Shan Dong)Co., Ltd.	25G30R8SF1	sterile,single-use
Propofol Injectable Emulsion	Guangdong Jiabo	H20051842
Sevoflurane for Inhalation	Baxter Healthcare Corporation	H20140431
SILK BRAIDED NON-ABSORBABLE SUTURE	ETHICON	V502413	sterile,single-use
Single-use sterile urinary catheter kit	Beijing Huatongtong Technology Co., Ltd.	C14-05-03	sterile,single-use
Sterile surgical blade	Shanghai Lianhui Medical Supplies Co., Ltd.	####################	sterile,single-use
Synthetic absorbable surgical sutures	Covidien IIC	A4L1357Y	sterile,single-use
Ultrsonic equipment	medical ultrasound instrument	E40482	stable,probe sterile