Gestational trophoblastic neoplasm in a patient with end-stage renal failure (ESRF): the challenges and lessons learnt

BMJ Case Rep. 2022 May 18;15(5):e249474. doi: 10.1136/bcr-2022-249474.


Gestational trophoblastic neoplasm (GTN) in end-stage renal failure (ESRF) has not been reported. We reported an unprecedented case of GTN in ESRF from an antecedent partial mole. She had total abdominal hysterectomy and bilateral salpingectomy following the diagnosis as the disease was confined to the uterus. A histopathological examination confirmed an invasive mole. Consequently, she received a total of four cycles of single-agent intravenous actinomycin D as she was at low risk. Despite initial response, her disease metastasised to her right kidney for which radiotherapy was given, followed by a total of 33 doses of weekly paclitaxel. She responded to the chemotherapy and currently remains in remission. The choice of chemotherapy and their side effects due to ESRF remain the main challenges in her management. Total hysterectomy should be considered as the first-line treatment for a hydatidiform mole to prevent GTN. A multidisciplinary approach is important to optimise the efficacy of the treatment with minimal compromise of her safety.

Keywords: Dialysis; Gynecological cancer.

Publication types

  • Case Reports

MeSH terms

  • Dactinomycin / therapeutic use
  • Female
  • Gestational Trophoblastic Disease* / complications
  • Gestational Trophoblastic Disease* / therapy
  • Humans
  • Hydatidiform Mole* / complications
  • Hydatidiform Mole* / surgery
  • Hysterectomy
  • Kidney Failure, Chronic* / chemically induced
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / therapy
  • Pregnancy
  • Retrospective Studies
  • Uterine Neoplasms* / complications
  • Uterine Neoplasms* / surgery


  • Dactinomycin