Background: INVASIVE MOLE is responsible for most cases of localized gestational trophoblastic neoplasia. Gestational trophoblastic disease describes a number of gynecologic tumors that originate in trophoblastic layer including hydatidiform MOLE (complete or partial), INVASIVE MOLE, choriocarcinoma, placental site trophoblastic tumor and epitheloid trophoblastic tumor. INVASIVE MOLE may arise from any pregnancy event although in most cases is diagnosed after molar pregnancy. Overall cure rate in low risk patients is nearly 100% and in high-risk patient 90%. In rare cases, molar tissue traverses thickness of myometrium and leads to perforation and acute abdomen and INVASIVE MOLE infrequently metastasis. The best treatment option is chemotherapy (according to stage and score with single or multiple agent) and in patients that fertility is not the matter, hysterectomy can be done.Case Presentation: A 41 years old G3P2ab1 woman referred to Firouzgar hospital 2 months after curettage of molar pregnancy with vaginal bleeding and acute abdomen.In workup, HCG 224000mIU/ml and evidence of metastasis was detected.Chemotherapy due to stage 3 and score 9 and surgery due to acute abdomen was done. This case was reported for its rarity.Discussion: This case reported about ovarian metastasis and uterine rupture with acute abdomen and involvement of omentum in metastatic INVASIVE MOLE. Lack of surveillance led to extensive morbidity. Management of this patient was successful.In follow up, she was free of disease without sequel of any kind for five years now.

Gestational trophoblastic neoplasia (GTN) is a rare neoplasm and is a spectrum of proliferative disorders of placenta. INVASIVE MOLE is a subtype of GTN that almost always arises after molar pregnancy. This report presents a 35-year-old woman with an atypical presentation of INVASIVE MOLE after a normal pregnancy. The patient presented with a complaint of vaginal bleeding after normal vaginal delivery. INVASIVE MOLE was diagnosed based on findings of imaging and elevated beta human chorionic gonadotropin (ß-hCG) levels. Hysterectomy was finally decided upon due to severe vaginal bleeding and the patient’s request. Although GTN occurs after normal delivery, the patient recovered without receiving chemotherapy. It is important to consider all subtypes of GTN as a differential diagnosis of patients with abnormal postpartum bleeding and elevated ß-hCG levels even after a normal pregnancy.

P A twin pregnancy with a complete hydatidiform MOLE with a coexistent foetus (CHMF) is a rare condition that typically results in poor pregnancy outcomes. For patients with refractory vaginal bleeding, termination of pregnancy is more appropriate. However, unified methods for termination remain to be explored. In the present study, we reviewed the termination measures in four cases of twin pregnancy with CHMF. Additional understanding of this condition will aid in the treatment of women with this condition and improve their pregnancy outcomes.

An INVASIVE MOLE is a rare form of gestational trophoblastic disease in which the molar tissue invades into the deep myometrium, cervical stroma, blood vessels or extrauterine sites. This report is of an INVASIVE MOLE of spleen that has originated from an ectopic pregnancy, which was primarily though to be a choriocarcinoma.

Early recognition of Gestational Trophoblastic Neoplasm (GTN) will maximize the chances of cure with chemotherapy but some patients present with many different symptoms months or even years after the causative pregnancy making diagnosis difficult. Clinicians should be aware of the possibility of GTN in any reproductive age woman with bizarre central nervous system, gastrointestinal, pulmonary symptoms or radiographic evidence of metastatic tumor of unknown primary origin. We reported five cases of metastatic gestational trophoblastic neoplasms with bizarre pulmonary symptoms, acute abdomen, neurologic symptoms presenting without gynecological symptoms.