Molar pregnancy

Case contributed by Dr Morouj Shaggah

Presentation

History of nonspecific abdominal pain, distention, nausea and vaginal spotting.

Patient Data

Age: 45 years
Gender: Female

MRI with contrast

mri

A large expansile heterogeneous mass fills and distends the endometrial cavity.

It demonstrates high signal intensity and numerous small internal cystic spaces on T2-WI and low signal intensity on T1-WI with avid heterogeneous enhancement.

No fetal parts seen. No extrauterine extension or pelvic lymphadenopathy. 

The right ovary shows a dominant follicle, otherwise, both ovaries appear unremarkable. The cervix appears unremarkable. Minimal pelvic free fluid.

MRI features are highly suggestive of molar pregnancy.

Case Discussion

The patient was referred for pelvic MRI for a suspicious uterine lesion on ultrasound.

Serum β-hCG was markedly elevated at about ~ 750,000 IU/L.

The histopathology of suction - evacuation specimen showed: multiple pieces of decidua, multiple chorionic villi with hydropic changes and mild polar circumferential trophoblastic proliferation, consistent with molar pregnancy-partial mole.

Although β-hCG dropped to 20,000 IU/L after evacuation, it increased back to 95,000 IU/L after two weeks, raising suspicion of persistent gestational trophoblastic neoplasia (GTN)

The patient was started on chemotherapy, β-hCG dropped back to ~20,000 IU/L after the first dose, and reached ~ 6 IU/L after the fifth dose, and now on monthly β-hCG monitoring as a follow-up plan.

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