Nida JareemitMongkol BenjapibalFaculty of Medicine, Siriraj Hospital, Mahidol University2020-06-022020-06-022020-01-01Case Reports in Oncology. (2020), 485-490166265752-s2.0-85085308099https://repository.li.mahidol.ac.th/handle/123456789/56288© 2020 The Author(s). Published by S. Karger AG, Basel. Gestational trophoblastic neoplasia (GTN) is an uncommon group of pregnancy-related malignancies. Delayed diagnosis is a prognostic factor for worse outcome. GTN is even harder to diagnose if the site of metastasis is uncommon. The reported case is a 27-year-old G₂P₁A₁ woman who presented to our center with acute transient generalized tonic-clonic seizure. She had developed hemoptysis for the 2 preceding weeks, which had been treated as pneumonia. She had then noticed multiple gum lesions and vaginal spotting 1 week before her presentation. Her serum β-human chorionic gonadotropin level was 77,474 IU/L without evidence of pregnancy. She was diagnosed with GTN with lung, brain, and gum metastases. The patient was staged as IV with a World Health Organization prognostic score of 14. Etoposide, methotrexate, actinomycin D alternating with cyclophosphamide, and vincristine weekly (EMACO) were given. The gum lesions disappeared after 2 cycles of the multiagent chemotherapy, and complete remission was achieved after 8 cycles. This case study will increase awareness of uncommon metastatic sites of GTN. Any associated vaginal bleeding should be considered a clue to metastatic GTN.Mahidol UniversityMedicineArticleSCOPUS10.1159/000506329