Invasive mole

Case contributed by Morouj Shaggah


Known case of molar pregnancy presented for follow-up with rising B-HCG levels.

Patient Data

Age: 30 years
Gender: Female

Pelvis CT


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.

Pelvis US


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.

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