Early recognition of gestational trophoblastic neoplasms (GTN) will maximize the chances of cure with chemotherapy but some patients present with many different symptoms months or even years after the causative pregnancy making diagnosis difficult. Clinicians should be aware of the possibility of GTN in any reproductive age woman with bizarre central nervous system symptoms, gastrointestinal symptoms or radiographic evidence of metastatic tumor of unknown primary origin. We reported two cases of metastatic gestational trophoblastic neoplasms with bizarre pulmonary symptoms, one patient with small bowel metastasis, and two patients with brain metastasis presenting with unusual manifestations.