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

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