Bilateral internal pudendal artery angiographic embolization of labial metastasis from gestational trophoblastic neoplasia
Bernadette C. Yap, MD; Agnes L. Soriano-Estrella, MD, MHPEd, FPOGS, FPSSTD
Department of Obstetrics and Gynecology, Philippine General Hospital-University of the Philippines-Manila
Patients with Gestational Trophoblastic Neoplasia commonly experience bleeding from metastatic sites in the vulvovaginal area. Digital pressure and early institution of chemotherapy usually achieve control of the hemorrhage, but massive hemorrhage ensues in some cases. This paper documents the case of a 48 year-old Gravida8 Para7 (7017) who previously underwent total hysterectomy for endometrial mass. On histopathologic examination, it was diagnosed as Choriocarcinoma. Patient was then advised multiagent chemotherapy indicated for high-risk metastatic gestational trophoblastic neoplasia. Chemotherapy was discontinued due to intermittent, profuse, vaginal bleeding that rendered the patient anemic, a contraindication to starting another cycle of chemotherapy. Despite direct pressure on the vulvar mass, the bleeding became intractable, rendering the patient hypotensive and hooked on ionotropes for hemodynamic stability. The only option remaining for the patient was emergency embolization.
This paper documents the first embolization to be done in the Philippines for labial metastasis from gestational trophoblastic neoplasia.