Vaginal metastasis in gestational trophoblastic neoplasia: Experience from Sheffield trophoblastic disease Centre and recommendations for management

•Cases of vaginal metastasis are rare, and are reported to occur in 4.5–27% of cases of gestational trophoblastic neoplasia.•Approximately 45% of cases are complicated by major vaginal haemorrhage.•The presence of vaginal metastases in gestational trophoblastic neoplasia does not confer a worse prognosis.•Presence of vaginal metastases should not alter maagement plans, with tailored treatment determined by patient factors.•Chemotherapeutic regimens should be based upon World Health Organisation prognostic scores. Gestational trophoblastic neoplasia (GTN) is rare in the UK, with an estimated incidence of one in 50,000 live births. Cases of vaginal metastasis are even rarer, with only eight case series reporting 187 cases over the past 40 years. Management recommendations in the literature are scarce despite the potential risk of massive, potentially life-threatening vaginal haemorrhage. This retrospective cohort study with interval analysis was performed at Sheffield Trophoblastic Disease Centre. It included all patients diagnosed with GTN with documented evidence of vaginal metastases between 1 January 1974 and 31 December 2023. Twenty-five patients with GTN and vaginal metastases were identified during the study period, accounting for