Vaginal metastases in gestational trophoblastic neoplasia

Objective: To evaluate the clinical experience and outcomes of patients with gestational trophoblastic neoplasia (GTN) complicated by vaginal metastases. STUDY DESIGN: A review of patients with vaginal metastases from GTN treated at a regional trophoblastic disease center from 1962 to 2006. Results: Vaginal metastases were present in 36 (4.5%) of the 804 patients treated for GTN. FIGO stage was II in 13 patients (36%), III in 22 patients (61%) and IV in 1 patient (3%). Twenty-three patients (65%) were low-risk by modified WHO criteria. The vaginal metastases were most frequently single lesions (61%) on the anterior vaginal wall (49%) with a histologic classification of choriocarcinoma (67%). Significant bleeding necessitated blood transfusion (median, 7 units; range, 1-26 units) in 13 patients (36%). Seven patients (19%) required 1 or more procedures for control of bleeding, including excision, suturing and/or hypogastric artery ligation/embolization. Twenty-three patients (64%) received single-agent chemotherapy with methotrexate and/or actinomycin-D, while 13 patients (36%) received multiagent chemotherapy regimens. Conclusion: Overall, 29 (81%) of 36 patients with vaginal metastases were cured. Vaginal metastasis from GTN does not uniformly confer a worse prognosis or necessitate multiagent chemotherapy, although procedures for control of bleeding may be required.