Postmenopausal mixed gestational trophoblastic neoplasia: a case report and review of the literature.

Background: Mixed gestational trophoblastic neoplasia (GTN) is an exceptionally rare form of GTN, characterized by the coexistence of choriocarcinoma (CC) and/or placental site trophoblastic tumor (PSTT) and/or epithelioid trophoblastic tumor (ETT). GTN rarely presents in women beyond the reproductive age. Case Description: We present a case of a 65-year-old woman diagnosed with mixed GTN (CC + ETT + PSTT). Initially, she was diagnosed with an undefined subtype of GTN, with the possibility of concurrent ovarian and/or endometrial cancer. The patient underwent multi-agent chemotherapy initially and responded well, but she developed severe toxic reaction to the treatment. After symptomatic supportive treatment, she underwent cytoreductive surgery and was given sequential chemotherapy. She responded well but then developed sepsis and other severe side effects. Consequently, the chemotherapy was suspended, and the disease progressed. On the 36th day of the interval, the family decided to discontinue supportive treatment due to financial difficulties, and the patient passed away three days later. We also reviewed 45 cases of mixed GTN from existing literature to deepen clinician understanding of this condition. Conclusions: Mixed GTN is a rare malignant neoplasm of the trophoblastic tissue, particularly in postmenopausal women. The risk of misdiagnosis is high, and definitive treatment protocols remain elusive. Future research must further explore the methods to promote differential diagnosis, chemotherapy and surgery regimens, their timing, and novel therapeutic modalities such as adjuvant immunotherapy, in order to enhance treatment outcomes.