EP20.26: Recurrent invasive mole within the myometrium

Invasive mole is characterised by enlarged hydropic villi invading myometrium, vascular spaces, or extrauterine sites. Not resolving spontaneously, is considered gestational trophoblastic neoplasia (GTN). Low risk GTN has less than 5-10% risk of recurrence that occurs at a median time of six months after the end of primary treatment but rarely many years later. Clinical presentation is metrorrhagia with an increase in HCG. Histologic confirmation is usually not pursued. We present a case of a 32-years old woman with a previous invasive mole after molar pregnancy treated with methotrexate in July 2020. In October 2023 she presented with heavy vaginal bleeding. The TV ultrasound showed within the posterior uterine wall a hyperechoic myometrial mass of 45 mm, with undefined margins, inhomogeneous echostructure, rich vascularisation. HCG was 110294 UI/L. Hysteroscopy showed decidualised endometrium and well inserted IUD. PET-CT was negative for metastasis. The tumour board considered the patient high risk and started her on EMACO. After 3-cycles, TV examination showed a reduced mass of 35 mm, no internal vascularisation. HCG level was 23 UI/L. She is now set to continue EMACO until HCG normalisation and for 2-cycles after. Response to treatment is evaluated by laboratory testing in the lack of defined US features, however TV US examinations will be performed. Decrease of perfusion occurs very early, while reduction or disappearance of lesions is slow, and US alterations may persist long after HCG normalisation. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.