Short communication: A review of the management by hysterectomy of 25 cases of gestational trophoblastic tumours from March 1993 to January 2006

We reviewed 25 cases of gestational trophoblastic tumours referred for surgical management from Charing Cross Hospital (the London centre for gestational trophoblastic disease [GTD]) over a 13-year period. The operation performed was total abdominal hysterectomy, with lymph node sampling in 9/25 (36%) women and bilateral salpingo-oophorectomy in 11/25 (44%) women. Radical hysterectomy and unilateral parametrectomy was required in 3/25 (12%) women. Three of 25 (12%) women failed to survive, i.e. the overall rate of survival was 88%. Management by hysterectomy of primary drug-resistant and relapse cases of GTD is a useful and safe adjunct to chemotherapy.

Placental site trophoblastic tumor with an ovarian metastasis

Placental site trophoblastic tumors (PSTT) are the rarest form of gestational trophoblastic disease (GTD). The clinical management of PSTT differs from the other forms of GTD as surgery plays a more important role. The most common metastatic sites are the lung, liver, and vagina while spread to the adnexa is relatively unusual. We describe a case of a 35-year-old woman presenting with PSTT and ovarian metastasis who was successfully treated with radical hysterectomy, bilateral oophorectomy, pelvic lymph node dissection, and postoperative chemotherapy. The case highlights the possibility of ovarian metastases despite normal preoperative imaging and confirms the value of multidisciplinary management of this rare illness.

Uterine arteriovenous malformation: fertility-sparing surgery using unilateral ligation of uterine artery and ovarian ligament

Arteriovenous malformations (AVM) are rarely found in the uterus and are usually acquired. The method of treatment is determined by symptoms, desire for future fertility, extent, and location of the malformation. Selective ligation of the vessels supplying the malformation is an effective treatment option when conservative methods have failed and uterine preservation is of primary concern. Measurement of uterine O(2) saturation and perfusion index has been shown to be effective in the intraoperative assessment of uterine viability, pre- and postligation of pelvic vasculature. We present the case of a 32-year-old woman with a postmolar uterine AVM treated surgically with unilateral uterine artery and ovarian ligament ligation.