Hemostatic Radiotherapy for Life-Threatening Vaginal Hemorrhage in High-Risk Gestational Trophoblastic Neoplasia Following Partial Hydatidiform Mole: A Rare Case Report.

INTRODUCTION: Gestational trophoblastic neoplasia (GTN) developing after molar pregnancy is highly responsive to treatment when diagnosed early. However, delayed recognition, particularly following a partial hydatidiform mole, may lead to advanced disease with life-threatening hemorrhagic complications. CASE DESCRIPTION: A 47-year-old multiparous woman underwent uterine evacuation at an outside hospital on December 2, 2025, where histopathological examination was reported as a partial hydatidiform mole. No serial quantitative serum β-hCG monitoring was performed after evacuation. She subsequently presented on January 23, 2026, with massive vaginal bleeding, hemorrhagic shock, and severe anemia (hemoglobin 5.7 g/dL). Emergency exploratory laparotomy with total abdominal hysterectomy was performed. Histopathological evaluation of the surgical specimen confirmed an invasive hydatidiform mole characterized by myometrial invasion of hydropic chorionic villi with extensive hemorrhage and necrosis. The postoperative course was complicated by recurrent vaginal bleeding due to clinically suspected vaginal metastasis, while chest imaging demonstrated pulmonary metastases consistent with FIGO stage III GTN. Hemostatic radiotherapy (20 Gy in five fractions) successfully controlled the bleeding and improved the hemoglobin level to 9.6 g/dL. Following hemodynamic stabilization, the patient was classified as having high-risk GTN (FIGO/WHO prognostic score 8) and was treated with multi-agent EMA-CO chemotherapy, achieving an excellent biochemical response with normalization of serum β-hCG during follow-up. CONCLUSION: Recurrent or massive vaginal bleeding after molar pregnancy should prompt immediate evaluation for GTN. Early diagnosis, multidisciplinary management, and timely risk-adapted chemotherapy are essential to optimize outcomes in patients with high-risk disease.