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Invasive mole in a perimenopausal woman: a case report and systematic review

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Abstract

Objective

Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumors. We present a case of a perimenopausal woman with invasive mole. A systematic review was performed to identify reports on GTD in older women and to determine adequate treatment options.

Case

A 51-year-old perimenopausal woman was admitted to hospital with abdominal feeling of pressure and nausea. Diagnostic curettage revealed hydatidiform mole. She also presented symptomatic hyperthyroidism with hypertensive blood pressure and uneasiness. After treatment with beta blockers and carbimazole, the patient underwent abdominal hysterectomy and bilateral oophorosalpingectomy. Histopathological examination confirmed an invasive hydatidiform mole (IHM). Serum β-hCG has decreased from initially 300,000–100 unit/L after 4 weeks.

Data sources

A systematic review was performed to identify all prior cases of GTD in women over 50. We searched in Medline, The Cochrane Library and Embase, to identify any articles published in the English language after 1970 and before Oct 31, 2013 pertaining to GTD in older woman (50 years or older).

Tabulation, integration, and results

Ten records were included in the systematic review, involving 203 cases of trophoblastic disease in older women. Although the diagnosis of GTD in older women is rare, it should be considered especially in patients with suspicious intrauterine findings in transvaginal ultrasound examinations. Different treatments were performed. In a limited number of reports, older women with GTD underwent initial hysterectomy. Benefits are avoidance of chemotherapy-induced toxicity and reduced risk of recurrence. Hysterectomy should be performed by an experienced surgeon.

Conclusion

It is concluded that GTD is very rare in peri- or postmenopausal women. Treatment has to be individualized, and hysterectomy can be considered as an appropriate option.

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Conflict of interest

The authors did not report any potential conflicts of interest.

Informed consent

Written informed consent was obtained from the patient for publication of this case report.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Medical Center, Caritas Hospital St. Josef, University of Regensburg, Landshuter Strasse 65, 93053, Regensburg, Germany

    Sophie Freifrau von Welser & Olaf Ortmann

  2. Department of Internal Medicine III, University Medical Center, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Matthias Grube

Authors
  1. Sophie Freifrau von Welser
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  2. Matthias Grube
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  3. Olaf Ortmann
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Correspondence to Sophie Freifrau von Welser.

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von Welser, S.F., Grube, M. & Ortmann, O. Invasive mole in a perimenopausal woman: a case report and systematic review. Arch Gynecol Obstet 292, 1193–1199 (2015). https://doi.org/10.1007/s00404-015-3777-z

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  • DOI: https://doi.org/10.1007/s00404-015-3777-z

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