Presentation
Hydatidiform mole 6 months previously, evacuated. Follow up scan with plateauing of beta HCG
Patient Data
Uterus: Normal in size with multiple ill-defined hypodense lesions, with peripheral area of hyperenhancement in fundus extending along the posterior wall of the uterus. Few non enhancing hypodense areas are noted within (necrosis). Prominent engorged parametrial vessels are noted.
Both ovaries appear bulky with multiple cysts, likely to be theca luteal cysts.
Lungs: Few scattered solid nodules, few of them in subpleural location are seen in both lung
parenchyma - suspicious for pulmonary metastases..
Case Discussion
Gestational trophoblastic tumors are either invasive mole or malignant choriocarcinoma.
Choriocarcinoma is carcinoma of chorionic epithelium which goes into excessive invasive trophoblastic overgrowth and extensive penetration by trophoblastic elements, that can erode blood vessels and can penetrate into peritoneum also.
Choriocarcinoma leads to extensive necrosis and hemorrhage.
Invasive moles do not metastasize, whereas choriocarcinoma frequently metastasis to lungs, vagina, and brain.
Usually occur following hydatiform mole, abortion, and ectopic pregnancy.
Imaging
CT: Enlarged uterus with discrete, central and infiltrative mass with areas of necrosis and hemorrhage.
Ultrasound: Not specific and variable
Treatment depends on the type and stage of the tumor. Gestational choriocarcinoma has good prognosis with chemotherapy.
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