Presentation
Known case of molar pregnancy presented for follow-up with rising B-HCG levels.
Patient Data
Evidence of an irregular early arterial hyperenhancing area invading the left aspect of the myometrium with a multiloculated right adnexal cystic lesion.
The left ovary appears unremarkable.
No enlarged pelvic lymph nodes.
An echogenic area with increased vascularity is noted invading the myometrium.
A multiloculated right adnexal cystic lesion is seen, which may suggest theca lutein cyst.
Case Discussion
This patient is a known case of molar pregnancy presented for follow up. Previous serial B-HCG levels demonstrated regression and on the 7th-week post evacuation a rise in B-HCG levels was noted; ( pre-evacuation reading was ~ 430000 IU/L, two weeks post-evacuation it was ~ 1000 IU/L and on the 7th-week it was ~ 3000 IU/L).
Pan CT scan was requested to rule out metastasis. A suspicious highly vascular lesion is seen invading the myometrium without detectable metastatic lesions.
In correlation with the clinical scenario, rising B-HCG levels and presence of chorionic villi in the histopathology specimen (which rules out choriocarcinoma)1, features are most suggestive of invasive molar pregnancy.
The patient was started on chemotherapy, and B-HCG levels are declining.