Presentation
History of miscarriage and curettage 4 months ago. Recurrent vaginal bleeding for 2 months and serum BHCG level was 35,000 mIU/ml. After receiving 4 sessions of chemotherapy referred to pelvic MRI with a BHCG level of 29,000 mIU/ml.
Patient Data
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The uterus is mildly enlarged measuring about 7.8 x 9.5 x 12 cm and show heterogeneous parenchymal signal intensity.
There is 5.0 x 5.7 x 6.5 cm heterogeneous enhancing endometrial lesion includes multiple internal tiny cystic components with adhesion to the anterior uterus myometrium associated with tortuous vascular flow voids within its as well as within the anterior myometrial walls.
Case Discussion
The clinical, radiological and laboratory data are in favor of gestational trophoblastic disease - invasive mole type. The suggestive imaging features are poorly defined endometrial mass lesion with invasion and distortion of the uterine zonal structures and an indistinct interface between the endometrial mass lesion and the myometrium as well as heterogeneous enhancement. Grape-like nonenhancing tiny cystic lesions within the trophoblastic proliferation are noted. Histopathological analysis is necessary to confirm the diagnosis.
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