The following is the summary of “Long-term outcome of ultrasound-guided focused ultrasound ablation for gestational trophoblastic neoplasia in the cesarean scar: a case report” published in the December 2022 issue of Women’s health by Qu, et al.

One of the medical oncology’s success stories is the treatment of gestational trophoblastic neoplasia (GTN). Although GTN in the cesarean scar is uncommon, hysterectomy or localized uterine lesion excision is usually necessary due to chemoresistant lesions and/or excessive bleeding. Researchers present a case of a patient with postmolar GTN in the cesarean scar successfully treated with ultrasound-guided high-intensity focused ultrasound (HIFU) to avoid invasive surgery and save her uterus and fertility.

A 32-year-old female presented with a partial hydatidiform mole and was subsequently diagnosed as low-risk GTN (FIGO Stage I: 2 prognostic score). Due to ongoing hepatotoxicity and ovarian reserve impairment, the fifth cycle of chemotherapy had to be halted. The uterine lesion, however, remained (diameter of the residual uterine lesion in the cesarean scar: 2.0 cm). As a result, HIFU therapy was administered while being guided by ultrasound. During the HIFU procedure, a noticeable shift in grayscale was seen. To measure how well the ablation worked, doctors used color Doppler ultrasound and contrast-enhanced ultrasound (CEUS). The vascularity signal disappeared on color Doppler ultrasound, and contrast-enhanced ultrasound demonstrated no perfusion in the lesion within the cesarean scar. 1 month following HIFU treatment, the uterine lesion had clearly decreased in size. After 48 days, the menstrual cycle restarted normally after HIFU. 

At the 4-month follow-up, the GTN lesion had completely disappeared, and the number of chemotherapy sessions had been reduced. As of the 58th month of follow-up, the patient has shown no symptoms of recurrence. Patients with GTN of the cesarean scar who exhibit chemoresistance or are not candidates for chemotherapy may benefit from ultrasound-guided HIFU rather than lesion removal. Ablation of the residual uterine lesion could be performed non-invasively, saving the uterus and the woman’s ability to have children while avoiding the perioperative dangers associated with resecting the lesion, such as severe hemorrhage.

Source: bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-02114-0