Ectopic Molar Pregnancy In A Patient With Endometriosis
Authors:Raheela Naz1*,Mark Omar2,Bramara Guruwadayarhalli3,Srividhya Budithi4
1. Clinical fellow,2,3,4. Consultant, Wrexham Maelor Hospital
Objective:
Case report highlights the importance of clinical suspicion and histopathological examination and follow up .
Case Report:
•A 32-years-old Primigravida attended hospital with heavy vaginal bleeding and lower abdominal pain at 6 weeks of gestational age.
•There was no history of previous pelvic inflammatory disease or abdominal surgeries.
•At presentation, her general condition and observations were within normal limits.
•Human Chorionic Gonadotropin(HCG) was 70738IU/L.
•Ultrasound showed an enlarged right ovary and no intrauterine gestational sac.
•The plan was to repeat HCG in 48 hours.
•The patient failed to attend the for follow up appointment and presented again after 2 weeks with vaginal spotting. Repeat HCG was 18556IU/L. Transvaginal ultrasound scan showed a 56mm x 44mm x 40mm highly vascular adnexal mass with “snowstorm” appearance( figure 4), normal looking ovaries , no free fluid.
•Emergency laparoscopy was performed which revealed a 6cm right tubal ectopic with increased vascularity.(figure 6)
•There was a small amount of blood in pelvis, few endometriosis spots (figure 7)in both ovarian fossae and pouch of Douglas.
•Right salpingectomy was performed, Specimen was sent for histology.
•Histology showed partial molar ectopic pregnancy. She was referred to the trophoblastic centre.
Discussion:
•Hydatidiform mole is a premalignant form of gestational trophoblastic disease that occurs from improper placental and fetal development.
•Ectopic and molar pregnancy are not rare events, but a molar ectopic is extremely rare,incidence being around 1.5 in every 1,000,000 pregnancies.
•Tubal molar ectopic is extremely rare, but in women with endometriosis the risk of ectopic pregnancy is more than double.
•In a partial mole, there is usually evidence of a fetus or fetal red blood cells.
•For the diagnosis of a partial mole, there must be histopathological evidence of trophoblast hyperplasia.
•Ultrasound is a helpful modality for diagnosis but histopathology is the gold standard for definite diagnosis.
Conclusion:
This case highlights the importance of sending histology specimens for all patients undergoing surgical intervention for ectopic pregnancy and ensuring that appropriate follow-up is in place.
Reference:
Allen L, Dawson C, Nascu P, Rouse T. A Molar Pregnancy within the Fallopian Tube.
Case Rep Obstet Gynecol. 2016;2016:4367181. doi: 10.1155/2016/4367181. Epub 2016 Dec 4. PMID: 28044117; PMCID:PMC5164888.Deliration: Case report was presented in COGI 2022
