Diagnosing and Managing Trophoblastic Lesions in Cesarean Scars: A Systematic Review.

Gestational trophoblastic disease (GTD) arises from an aberrant placenta and includes a spectrum of disorders ranging from premalignant to malignant. Changes in the epidemiology of GTD have been noted in various countries. Misdiagnosis can result in serious complications either because of the natural course of the disease or because of inadequate therapy that ensues. A systematic literature search was conducted in May 2025 using PubMed, Google Scholar, and the Cochrane Library. MeSH terms for "trophoblastic lesion" and "cesarean scar" were applied. Case reports describing trophoblastic disease in cesarean scars in women of any age were included. Non-trophoblastic lesions, cases not in cesarean scars, and non-English articles were excluded. Data were extracted from included studies and assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. The review followed PRISMA guidelines. Thirty-six case reports from 2006 to 2024 were included. Patients ranged from 22 to 54 years and were multiparous with prior cesarean sections. Common symptoms included vaginal bleeding, amenorrhea, and pelvic pain. Serum β-hCG levels varied, with elevated levels in choriocarcinoma (CC) and normal or low levels in atypical placental site nodules (APSNs) and epithelioid trophoblastic tumors (ETTs). ETT was the most frequent lesion type, followed by CC and APSNs. Diagnosis used transvaginal ultrasonography (TVUS), Doppler imaging, and magnetic resonance imaging (MRI), confirmed by histopathology. Treatment was mainly surgical; chemotherapy was used in CC cases. Outcomes were favorable, with no recurrence in follow-up. Trophoblastic lesions in cesarean scars require heightened clinical awareness due to their diagnostic complexity. Early identification using imaging and histopathology is crucial. This review emphasizes standardized diagnostic pathways and the need for studies on management protocols.