Successful uterine-sparing surgery in a case of localized chemoresistant gestational trophoblastic neoplasia: a case report

Introduction and importance: Gestational trophoblastic neoplasia (GTN) represents a spectrum of rare tumors originating from trophoblastic tissue. While chemotherapy is the standard treatment, chemoresistance can present a major management challenge, particularly when standard surgical options like hysterectomy threaten future fertility. Conservative uterine-sparing surgery for localized disease offers an alternative strategy to achieve remission while preserving reproductive potential in young patients. Case presentation: We report the case of a 22-year-old woman with a history of complete molar pregnancy who developed low-risk GTN. After initial treatment with methotrexate and a subsequent switch to actinomycin D because of hepatotoxicity, her β-human chorionic gonadotropin (β-hCG) levels initially declined but later rebounded. Imaging revealed a hypervascular uterine mass consistent with chemoresistant GTN. Due to her desire for fertility preservation and the absence of metastasis, she underwent uterine-sparing treatment with wedge resection of the uterine cornu. Histopathology confirmed choriocarcinoma with negative surgical margins. The postoperative course was uneventful, and her β-hCG levels normalized within 4 weeks. She remained in complete remission at her 6-month follow-up. Clinical discussion: Managing chemoresistant GTN in young patients requires a balance between oncologic cure and fertility preservation. When chemoresistant disease is localized and non-metastatic, conservative surgical resection can be an effective alternative to hysterectomy, avoiding multi-agent chemotherapy toxicity while achieving complete local control. Conclusion: This case illustrates the possibility and effectiveness of conservative, uterine-sparing surgery in young women with localized chemoresistant GTN, highlighting the value of personalized treatment strategies in carefully selected non-metastatic cases.