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We present a case of a 45-year-old woman who presented with irregular vaginal bleeding and menorrhagia for two months, with an episode of massive bleeding initiating 24 hours before with hemodynamic shock. Vaginal inspection showed a soft, rounded, friable mass in vaginal introitus. After hospitalization, blood transfusion and hydration, she was submitted to vaginal myomectomy with the withdrawal of a 12-cm white, solid, huge, pedunculated, leiomyoma; however, hysterectomy was performed due to persistent uterine bleeding. The postoperation period had no complications. Macroscopy showed a retraction of the myoma pedicle. Gynecologists should prioritize clamping of a pedicle before surgery, reducing its size if the tumor is large.

Fifty patients with metastatic or invasive gestational trophoblastic disease (GTD) were admitted at the "Hospital das Clínicas" of the Ribeirão Preto School of Medicine of the São Paulo University between January 1980 and December 1990. Of these 50 patients, 44 (88%) had GTD following abortion, 5 (10%) after term pregnancies and one (2%) after an ectopic pregnancy. Thirty five (70%) had invasive GTD and 15 (30%) metastatic GTD. The sites of metastases were: lung, 8 (53.3%), pelvis, 4 (26.6%), central nervous system, 2 (13.3%) and right auricle, 1 (6.6%). Human chorionic gonadotropin, pelvic arteriography and ultrasonography were used in the diagnosis of invasive GTD. 25 of the 41 patients with low-risk metastatic and invasive GTD were treated with monochemotherapy. There were 6 (24%) failures and the remaining 19 patients (76%) had complete remission of the disease after 2.89 mean cycles. Sixteen patients were treated with polichemotherapy, there were 2 (12.5%) failures and the remaining 14 had complete remission after a 2.3 mean cycles. No statistical differences between the two types of chemotherapy were observed. Four (8%) deaths were recorded.

A study was conducted to determine the effect of the form of uterine evacuation (curettage or vacuum aspiration) and of the use of oxytocin on the incidence of invasive/metastatic gestational trophoblastic neoplasia among patients with a diagnosis of molar abortion. The study was conducted on 42 patients with a histopathological diagnosis of benign complete hydatidiform mole and with a uterine height of more than 12cm. Twenty-five patients were submitted to uterine evacuation by curettage and 17 to uterine evacuation by vacuum aspiration. Twenty-seven of the same 42 patients received oxytocin to promote dilation of the cervix and/or partial mole expulsion, and 15 were not treated with this drug. Statistical analysis showed that the use of oxytocin before uterine evacuation was a factor contributing to a higher risk of development of invasive neoplasia, especially when associated with curettage of the uterus.