Gestational trophoblastic disease (GTD) and neoplasia (GTN) Quiz: Ace Your Exams
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A 33-year-old gravida 2, para 2 woman presents to the clinic to discuss recent laboratory and imaging results. Two months ago, she underwent suction dilation and curettage (D&C) for an abnormal pregnancy. The pathology report showed widespread hydropic villi, severe trophoblastic atypia, and a 46,XX karyotype. Since the D&C, she has been getting weekly human chorionic gonadotropin (hCG) levels drawn which have been slowly increasing over the past two weeks. Family history is notable for endometrial cancer diagnosed in her mother at age 72. Vital signs are unremarkable, and body mass index is 22 kg/m2. On pelvic exam, the vagina and cervix appear normal, but the uterus is enlarged. Heart, lung, abdominal, and neurologic exams are unremarkable. Recent pelvic ultrasound showed a 4 cm heterogeneous mass within the uterine cavity, and chest radiograph is normal. Risk assessment using the World Health Organization (WHO) criteria finds that the patient has low-risk disease. Which of the following is the most appropriate initial management?
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