Repeated ultrasound guided local infiltration of methotrexate in persistent gestational trophoblastic disease with myometrial invasion: case series and review of literature

Tamer H. Said, Yasser Elkerm


Gestational trophoblastic disease is a group of rare tumors that involve abnormal growth of cells inside a woman's uterus. An invasive mole is a hydatidiform mole that has grown into the muscle layer of the uterus. Invasive vesicular moles can develop from either partial or complete moles, but complete moles become invasive much more often than do partial moles. Invasive moles develop in a little less than 20% of women who have had a complete mole evacuated. Treatment of invasive mole is classically by giving systemic chemotherapy. Objectives of current study were to evaluate the effect of repeated local methotrexate injection in treatment of invasive mole. Cases with invasive mole assigned for local injection of 50 mg methotrexate in 10 cm normal saline using local injection in the myometrium under transvaginal ultrasound guidance. Follow up weekly till negative results are obtained. All cases showed rapid decrease of the level of b-hCG level after local injection and showed negative hormone results within 6 weeks after injection. Local methotrexate intra-myometrial local injection therapy has successful results in cases with persistent invasive hydatidiform mole and should be tried before referring them for systemic therapy.


Gestational trophoblastic disease, Methotrexate, Invasive mole

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Kaur B, Short D, Fisher RA, Savage PM, Seckl MJ, Sebire NJ. A typical placental site nodule (APSN) and association with malignant gestational trophoblastic disease; a clinicopathologic study of 21 cases. Int J Gynecol Pathol. 2015;34(2):152-8.

Berkowitz R, Ozturk M, Goldstein D, Bernstein M, Hill L, Wands JR. Human chorionic gonadotropin and free subunits' serum levels in patients with partial and complete hydatidiform moles. Obstet Gynecol. 1989;74(2):212-6.

Lawrie TA, Alazzam M, Tidy J, Hancock BW, Osborne R. First-line chemotherapy in low-risk gestational trophoblastic neoplasia. Cochrane Database Syst Rev. 2016;2016(6):CD007102.

Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC, Pecorelli S; FIGO Committee on Gynecologic Oncology. Gestational trophoblastic neoplasia, FIGO 2000 staging and classification. Int J Gynaecol Obstet. 2003;83(Suppl 1):175-7.

Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010;376(9742):717-29.

Ngan HY, Kohorn EI, Cole LA, Kurman RJ, Kim SJ, Lurain JR, Seckl MJ, Sasaki S, Soper JT. Trophoblastic disease. Int J Gynaecol Obstet. 2012; 119(Suppl 2):S130-6.

Ashton E, Szutowska M, Shafer A, Hoffman J. Attempted conservative management of a placental site trophoblastic tumor: a case report. Conn Med. 2014;78(8):475-7.

Numnum TM, Kilgore LC, Conner MG, Straughn JM Jr. Fertility sparing therapy in a patient with placental site trophoblastic tumor: a case report. Gynecol Oncol. 2006;103(3):1141-3.

Pfeffer PE, Sebire N, Lindsay I, McIndoe A, Lim A, Seckl MJ. Fertility-sparing partial hysterectomy for placental-site trophoblastic tumour. Lancet Oncol. 2007;8(8):744-6.

Wang Q, Fu J, Hu L, Fang F, Xie L, Chen H, He F, Wu T, Lawrie TA. Prophylactic chemotherapy for hydatidiform mole to prevent gestational trophoblastic neoplasia. Cochrane Database Syst Rev. 2017;9(9):CD007289.

Berkowitz RS, Goldstein DP. Clinical practice. Molar pregnancy. N Engl J Med. 2009;360(16): 1639-45.

Su WH, Wang PH, Chang SP. Successful treatment of a persistent mole with myometrial invasion by direct injection of methotrexate. Eur J Gynaecol Oncol. 2001;22(4):283-6.

Alazzam M, Tidy J, Osborne R, Coleman R, Hancock BW, Lawrie TA. Chemotherapy for resistant or recurrent gestational trophoblastic neoplasia. Cochrane Database Syst Rev. 2016; 2016(1):CD008891.

Tsukihara S, Harada T, Terakawa N. Ultrasound-guided local injection of methotrexate to treat an invasive hydatidiform mole. J Obstet Gynaecol Res. 2004;30(3):202-4.