Question

Patient with post molar evacuation, now has lesion in lungs with cannon ball appearance. Which is the best management?

• A. Hysterectomy
• B. Emaco regimen
• C. Inj. methotrexate
• D. Multiple dose of Inj. methotrexate

Hint:

Cannon-ball pulmonary metastases after molar evacuation indicate high-risk gestational trophoblastic neoplasia requiring multi-agent chemotherapy.

Answer 1

The Correct Option is B

Step 1: Identify the diagnosis. A patient with a history of molar evacuation now presenting with cannon-ball lesions in the lung is a classic description of Gestational Trophoblastic Neoplasia (GTN) with pulmonary metastasis -- specifically choriocarcinoma or high-risk GTN.

Step 2: Understand risk stratification. Pulmonary metastasis (cannon-ball appearance on CXR) after molar evacuation indicates high-risk GTN. High-risk GTN is defined by a WHO/FIGO prognostic score >= 7 and requires multi-agent chemotherapy.

Step 3: Select the correct chemotherapy regimen.

• EMACO regimen (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, Oncovin/Vincristine): This is the standard treatment protocol for high-risk GTN.
• Single-dose or multiple-dose Methotrexate alone: Used for low-risk GTN only (localized disease, no metastasis, low WHO score).
• Hysterectomy: May be used as an adjunct in selected cases (e.g., drug-resistant GTN), not as primary treatment for metastatic disease.

Conclusion: EMACO regimen is the treatment of choice for high-risk GTN with pulmonary metastasis.