Uncommon presentations of gestational trophoblastic disease

 

Objective:

We aimed to report three highly rare forms of gestational trophoblastic disease.

Case reports:

Case n°1:

Mrs KM, 32 years old, GIII PII, without any previous history, referred at 22 gestational weeks (GW) for morphological ultrasound. We found an unusual aspect of the placenta which appeared vacuolar in grape cluster. A partial mole was suspected and an pregnancy termination was proposed to the parents. The macroscopic appearance of the placenta was typically vesicular. Anatompathological  examination confirmed the diagnosis. The evolution was favorable under clinico-biological and ultrasound surveillance.

Case n°2:

Mrs RM, 38 years old, consulted at 8 GW for routine ultrasound. On ultrasound, we found a heterogeneous latero-uterine mass lateralized to the left in a honeycomb pattern , suggestive of ectopic molar pregnancy. The ßHCG level was very high at 180,000 mIU/ml. An emergency laparoscopy showed a left cornual ectopic pregnancy (EP). A uterine horn resection was performed. Anatomopathological examination concluded to a cornual molar pregnancy.

Case n°3:

Mrs NS aged 33 years, GII PI, admitted with pelvic pain with blackish metrorrhagia on 7 weeks amenorrhea. Endovaginal ultrasound showed an empty uterus with a thin endometrium, an effusion in the douglas with a heterogeneous latero-uterine mass containing a 6 GW embryo with cardiac activity . The ßHCG level was 40400 mIU/ml. Laparoscopic salpingectomy was performed. Anatomopathological examination concluded to a tubal molar pregnancy . Post-operative follow up was uncomplicated under bioloogical and clinico-radiological monitoring.

Discussion :

Although uncommon forms of gestational trophoblastic disease are rare, with an estimated frequency of 1 to 2 /million, they should be suspected each time we face unusual ultrasonography presentation.

Conclusion:

Molar pregnancy can present in several clinical forms. Careful ultrasound and ßHCG assay allow an early and adequate diagnosis.