To explore clinical manifestations, diagnosis, differential diagnosis, treatment and prognosis of a case of parturient with brain metastasis of gestational trophoblastic neoplasia (GTN) after full-term pregnancy, and review relevant literature.

On August 10, 2018, a patient with clinical diagnosis of brain metastasis of GTN after full-term pregnancy who had prenatal care and delivered in a city-level hospital in Chengdu was selected as research subject. Retrospective analysis method was used to collect clinical data of this patient and analyze her clinical manifestations, diagnosis and treatment process. In addition, from the establishment of China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP, Wanfang, PubMed and Ovid Medline databases to May 2020, literature was retrieved with key words including " gestational trophoblastic neoplasia" " postpartum" " brain metastasis" " chemotherapy" to search reported cases of patients with brain metastasis of GTN after full-term pregnancy. Clinical characteristics, diagnosis and treatment protocols of the parturient with brain metastasis of GTN after full-term pregnancy were analyzed and summarized. This study was in line with the World Medical Association Declaration of Helsinki revised in 2013.

①This patient was a 27-year-old female who had mole pregnancy (MP) during her first pregnancy. After curettage, she received follow-up of serum β-human chorionic gonadotropin (hCG). But after her serum β-hCG turned to normal once after MP curettage, she did not receive follow-up of serum β-hCG anymore. Then one year later, she was re-pregnant. On August 11, 2018, a live-born female full-term infant was delivered naturally, and there was no abnormality during delivery. On the 10th day after delivery, she had symptoms such as cough and headache. On the 15th day after delivery, she had CT detection for headache, and results showed multi intracranial mass, the biggest one was at right cerebellar hemisphere with size of 4.1 cm×3.9 cm×3.1 cm, and she was transferred to a superior hospital for further treatment. On the 16th day after delivery, she underwent lateral ventricle trepanation and drainage for intracranial hypertension in the superior hospital. Her serum β-hCG level was 400 588 mIU/mL. Considering brain metastases of GTN, it was recommended that she should take etoposide + methotrexate + actinomycin D + cyclophosphamide + vincristine (EMA-CO) combined chemotherapy treatment. But she gave up treatment on the 20th day after delivery, and then died at home after being discharged automatically. ②According to literature retrieval strategy formulated in this study, literature review results revealed that there was only 1 piece of foreign literature about one case with brain metastasis of GTN after full-term pregnancy within the latest 5 years, and this study reported 1 patient with irregular vaginal bleeding for 45 days, and cough blood for 7 days after full-term pregnancy. After completely examinations, she was diagnosed as brain metastasis of GTN. She was treated by 5-fluorouracil combined with actinomycin D chemotherapy regimen, intrathecal methotrexate injection and whole brain radiotherapy, and then her serum and cerebrospinal fluid β-hCG levels were significantly reduced. She underwent regular follow-up after discharge from hospital, and no GTN relapsed during 17-month follow-up.

GTN with brain metastasis after full-term pregnancy are highly malignant. Since GTN symptoms are easily covered by postpartum symptoms, diagnosis of brain metastasis of GTN after full-term pregnancy is difficult. Standardized treatment for these patients can effectively increase survival rates and improve prognosis.