scholarly journals A case of invasive mole presenting as perforation uterus and massive haemoperitonium

2016 ◽  
Author(s):  
Arti Sharma
Keyword(s):  
Acute Abdominal Pain ◽  
Uterine Perforation ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Distinct Subgroup ◽  
Rare Tumours ◽  
Packed Cell Transfusion ◽  
History Of ◽  
Invasive Mole ◽  
Uterine Fundus

Gestational trophoblastic neoplasia (GTN) are rare tumours that constitute less than 1% of all gynecological malignancies. Invasive mole is a distinct subgroup of GTN, which follows approximately 10-15% of complete hydatiform moles. This is a case of invasive mole presenting as uterine perforation and massive haemoperitonium. The 35 year old parous woman presented with severe pallor, acute abdominal pain and hemoperitonium. She gave history of evacuation of a molar pregnancy four month back. Her serum B-HCG was elevated (80,000 IU/ml). Laprotomy revealed perforation through the uterine fundus with purple discolouration and grapes like vesicle with massive haemoperitonium. Patient was managed by hysterectomy and packed cell transfusion was given. Postoperative followup with B-HCG levels was done and chemotherapy (methotrexate and folinic acid) was given.

scholarly journals Case Report: Acute abdomen presentation revealing a metastatic invasive mole with uterine rupture

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1115
Author(s):  
Fatma Dhieb ◽  
Miriam Boumediene ◽  
Armi Saoussem ◽  
Garci Mariem ◽  
Mathlouthi Nabil ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Uterine Rupture ◽  
Pulmonary Nodules ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Tumor ◽  
Clinical Presentations ◽  
History Of ◽  
Invasive Mole

Gestational trophoblastic neoplasia refers to the aggressive subset of gestational trophoblastic disease, including invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These tumors may have atypical clinical presentations that can mislead the diagnosis. The reported case is a 48-year-old woman in perimenopause, without any history of vaginal bleedings nor molar pregnancy, who presented to the Emergency Department with acute abdominal pain. Serum beta human chorionic gonadotropin (β-HCG) was highly elevated at 261 675.23 mIU/ml. A complicated invasive mole was suspected, and an abdominal computed tomography was performed, showing a moderate hemoperitoneum associated to complex cystic and solid uterine mass, with a common left iliac adenomegaly and multiple pulmonary nodules. MRI showed a multiloculated cystic uterine mass with zones of hemorrhage recalling an invasive mole with perforation of the posterior uterus wall, associated to a high abundance hemoperitoneum. The diagnosis of a metastatic invasive mole complicated of uterine rupture and hemoperitoneum was retained. A surgical intervention was decided immediately and a subtotal hysterectomy with bilateral annexectomy was done. Pathologic examination of the specimen was positive for an invasive mole. The patient was proposed for chemotherapy. This case study will increase awareness of unusual clinical presentations of gestational trophoblastic neoplasia We believe that our case will contribute to the literature not only because of the rarity of this entity in perimenopausal period, but also due the atypical clinical presentation as acute abdomen without vaginal bleeding nor history of molar pregnancy evacuation

THE RISK FACTORS OF MOLAR PREGNANCY

2017 ◽  
pp. 53-58
Author(s):  
Lam Huong Le
Keyword(s):  
High Risk ◽  
Gestational Trophoblastic Disease ◽  
Living Standard ◽  
Control Group ◽  
Uterine Perforation ◽  
Molar Pregnancy ◽  
Health It ◽  
Pregnancy Risk ◽  
History Of ◽  
And Control

Objectives: Molar pregnancy is the gestational trophoblastic disease and impact on the women’s health. It has several complications such as toxicity, infection, bleeding. Molar pregnancy also has high risk of choriocarcinoma which can be dead. Aim: To assess the risks of molar pregnancy. Materials and Methods: The case control study included 76 molar pregnancies and 228 pregnancies in control group at Hue Central Hospital. Results: The average age was 32.7 ± 6.7, the miximum age was 17 years old and the maximum was 46 years old. The history of abortion, miscarriage in molar group and control group acounted for 10.5% and 3.9% respectively, with the risk was higher 2.8 times; 95% CI = 1.1-7.7 (p<0.05). The history of molar pregnancy in molar pregnancy group was 9.2% and the molar pregnancy risk was 11.4 times higher than control group (95% CI = 2.3-56.4). The women having ≥ 4 times births accounted for 7.9% in molar group and 2.2% in control group, with the risk was higher 3.8 times, 95% CI= 1.1-12.9 (p<0.05). The molar risk of women < 20 and >40 years old in molar groups had 2.4 times higher than (95% CI = 1.1 to 5.2)h than control group. Low living standard was 7.9% in molar group and 1.3% in the control group with OR= 6.2; 95% CI= 1.5-25.6. Curettage twice accounted for 87.5%, there were 16 case need to curettage three times. There was no case of uterine perforation and infection after curettage. Conclusion: The high risk molar pregnancy women need a better management. Pregnant women should be antenatal cared regularly to dectect early molar pregnancy. It is nessecery to monitor and avoid the dangerous complications occuring during the pregnancy. Key words: Molar pregnancy, pregnancy women

scholarly journals Choriocarcinoma with uterine rupture presenting as acute haemoperitoneum and shock

2017 ◽  
Vol 6 (3) ◽  
pp. 1141 ◽  
Author(s):  
Mamour Gueye ◽  
Mame Diarra Ndiaye Gueye ◽  
Ousmane Thiam ◽  
Youssou Toure ◽  
Mor Cisse ◽  
...  
Keyword(s):  
Young Woman ◽  
Uterine Rupture ◽  
Gestational Trophoblastic Disease ◽  
Uterine Perforation ◽  
Molar Pregnancy ◽  
Rare Neoplasm ◽  
Trophoblastic Disease ◽  
Intraperitoneal Bleeding ◽  
Invasive Mole

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Invasive mole may perforate uterus through the myometrium resulting in uterine perforation and intraperitoneal bleeding. But uterine perforation due to choriocarcinoma is rare. We present a case of a young woman who presented 1 year after uterine evacuation of a molar pregnancy with invasive choriocarcinoma complicated by a uterine rupture and haemoperitoneum.

scholarly journals A Case of Invasive Mole

2017 ◽  
Vol 12 (2) ◽  
pp. 86-87
Author(s):  
Shahana Ahmed ◽  
Dipti Rani Shaha
Keyword(s):  
Hydatidiform Mole ◽  
The Body ◽  
Emergency Laparotomy ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Partial Hydatidiform Mole ◽  
Normal Limits ◽  
History Of ◽  
Invasive Mole

Invasive mole is a condition where a molar pregnancy, such as a partial hydatidiform mole or complete hydatidiform mole, invades the wall of the uterus, potentially spreading and metastasizing to other parts of the body. Here is a case who presented with history of evacuation for molar pregnancy. She presented with irregular P/V bleeding on and off and after admission silent perforation with massive haemoperitoneum was detected for which emergency laparotomy was done. She recovered and was followed up till her b-hCG levels were within normal limits. As patient presented to us with haemoperitoneum and on laparotomy, there was invasion into whole of the uterus, it could not be saved and hysterectomy was done.Faridpur Med. Coll. J. Jul 2017;12(2): 86-87

The practicability of FIGO 2000 staging for gestational trophoblastic neoplasia

2004 ◽  
Vol 14 (2) ◽  
pp. 202-205 ◽  
Author(s):  
H. Y. S. Ngan
Keyword(s):  
Solid Tumors ◽  
Classification System ◽  
Major Change ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Multicenter Trials ◽  
History Of Evolution ◽  
History Of ◽  
Risk Scoring ◽  
Criteria For Diagnosis

The FIGO 2000 gestational trophoblastic neoplasia (GTN) staging and classification has recommended three major changes in the management of GTN. The criteria for diagnosis of GTN following molar pregnancy were defined. The methods used for investigation of spread of the disease were recommended. A major change in the concept of FIGO staging in adding risk scoring to anatomical staging is novel but considered essential to best reflect the behavior of this disease which is different from other solid tumors. The history of evolution of this staging and classification system and practical points in applying this system were discussed. If this system would be used worldwide, it would be a big leap in the management of GTN where results can be compared among different centers and large multicenter trials would be possible.

scholarly journals Intramural ectopic pregnancy

2010 ◽  
Vol 18 (1-2) ◽  
pp. 30-31
Author(s):  
Biljana Lazovic ◽  
Vera Milenkovic
Keyword(s):  
Ectopic Pregnancy ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Elevated Serum ◽  
Normal Pregnancy ◽  
Primiparous Woman ◽  
Histopathological Analysis ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
History Of

Gestational trophoblastic neoplasia refers to a subset of gestational trophoblastic conditions characterized with persistently elevated serum ?-human chorionic gonadotropin, absence of a normal pregnancy, and a history of normal or abnormal pregnancies. We described a case of suspected ectopic molar pregnancy in a primiparous woman who had elevated ?-human chorionic gonadotropin and required chemotherapy to achieve remission. Final histopathological finding was ectopic pregnancy; no gestational trophoblastic neoplasia was found. This case stresses the importance of histopathological analysis in diagnosis of gestational trophoblastic neoplasia when ectopic pregnancy is present, considering that histopathological analysis is less sensitive for gestational trophoblastic neoplasia than for ectopic pregnancy.

scholarly journals Uterine Perforation on Invasive Hydatidiform Mole during EMACO Treatment

2016 ◽  
Author(s):  
Bram Pradipta
Keyword(s):  
Hydatidiform Mole ◽  
Broad Ligament ◽  
Posterior Part ◽  
Exploratory Laparotomy ◽  
Recurrent Bleeding ◽  
Uterine Perforation ◽  
Long Term Treatment ◽  
History Of ◽  
Invasive Mole ◽  
The Right

Objective: Improving skill and knowledge to recognize and manage a rare case of uterine perforation on invasive hydatidiform mole. Method: Case report. Result: A 42 years old Indonesian woman, Parity 2 Abortus 2 with history of 2 c-sections and 2 curettage, came with chief complaint of recurrent vaginal bleeding since 4 months before admission. Patient had a history of previous curettage with indication of hydatidiform mole and recurrent bleeding with no histopathology results. On examination we found a vesicular mass with infiltration, destroying the right-front uterine corpus, size 8x6 cm with an internal echo mass. Chest x-ray showed multiple nodules in the lung. The patient, considered as low risk Gestational Trophoblastic Neoplasia patient with FIGO Score of 6, underwent chemotherapy with 2 series of methotrexate . Due to the non-declining level of -hCG, the regimen was added with EMACO. In the process of chemotherapy, the pa-tient’s-hCG declined but then she complained of major abdominal pain. Exploratory laparotomy was performed and we found a mass sized 5x5x5 cm on the right side of the uterus at the broad ligament with a rupture at the posterior part of the mass sized 0.5x0.5 cm. Upon incision of the uterus, we found a mass from the right side protruding to the isthmus of the uterus. Histopathology showed necrosis, blood and chorionic villi in myometrium corresponding to invasive mole. Patient was then given another 5 series of EMACO and her condition was unremarkable during the remaining course of treatment. Conclusion: Invasive mole treatment is determined based on the risk factors. Uterine perforation still occurred in this case regardless of the decreasing hCG level during EMACO treatment. It emphasizes the importance of clinical examination as chemotherapy responsiveness. Long-term treatment can have a good prognosis but good collaboration between the gynecologist and the patient is essential. [Indones J Obstet Gynecol 2014; 3: 162-165] Keywords: EMACO, invasive mole, perforation

scholarly journals A Rare Case of Life-Threatening Invasive Mole

2018 ◽  
Vol 1 (2) ◽  
pp. 53-55
Author(s):  
Rajiv Shah ◽  
A.M. Samal
Keyword(s):  
Acute Abdominal Pain ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Emergency Laparotomy ◽  
Partial Mole ◽  
Life Threatening ◽  
Β Hcg ◽  
Invasive Mole ◽  
Uterine Fundus

A 23-year-old female with a known case of partial mole and under hCG follow up presented with acute abdominal pain and signs of hemoperitoneum. Emergency laparotomy revealed a molar pregnancy perforating through the uterine fundus, resulting in massive haemoperitoneum of 4 litres. Total abdominal hysterectomy was done. The serum β-hCG level regressed following hysterectomy.

Gestational trophoblastic disease in Nepalese women managed in B. P. Koirala Memorial Cancer Hospital

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16570-e16570
Author(s):  
J. Pariyar
Keyword(s):  
Brain Metastasis ◽  
Ethnic Group ◽  
Gestational Trophoblastic Disease ◽  
Uterine Perforation ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Cancer Hospital ◽  
Invasive Mole ◽  
Disseminated Disease

e16570 Background: Gestational trophoblastic disease (GTD) is potentially curable disease. Its incidence varies in different countries with high incidence reported in Japan (2/1000 pregnancies) and Mexico (2.5/1000 pregnancies). No studies have been reported regarding epidemiology, management and outcome of GTD in Nepal. Methods: The study was a descriptive case series. Case records of GTD patients attending B.P. Koirala Memorial Cancer Hospital, Nepal from 2001 to 2007 were analyzed. The main outcomes were measured in terms of duration, antecedent pregnancy, investigations, treatment and follow-up. Results: A total of 45 cases of gestational trophoblastic disease (GTD) were received from 26 districts of Nepal. The age of the patients ranged from 16 to 50 years with a mean age of 29.1 years (SD 9.4 years). Out of 45 cases 19 (43%) were of Tibeto-Burmese ethnic group and 15 (33%) belonged to Indo-Aryan ethnic group. There were 17 cases (37.8%) of hydatidiform mole, 6 were invasive mole (13.35%), 4 of persistent gestational trophoblastic tumour (8.8%) and 22 patients (48.8%) of choriocarcinoma. In 7 cases (15.5%) molar pregnancy had occurred in the first conception, another 7 cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. The most common presenting symptom was vaginal bleeding and 26 (57.8%) patients had anaemia. Theca Leuteal cyst was present in 11 (24.5%), 17 (37.8%) cases had lung metastasis, 4 (8.9%) had brain metastasis and another 4 (8.9%) had disseminated disease detecteted radiologically. Among the 45 cases 6 (13.3%) were treated with suction evacuation only; 9 (20%) underwent hysterectomy for uterine perforation, excessive hemorrhage and invasive mole. 28 (62.2%) cases underwent adjuvant chemotherapy among which 12 (26.6%) received single agent chemotherapy and 15 (33.3%) received EMA-CO regimen. Brain irradiation was required in a case with brain metastasis. Five (11.1%) cases with disseminated disease and high WHO risk score left the hospital against medical advice. There were 3 (6.7%) mortalities. 37 (82.1%) cases are in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. No significant financial relationships to disclose.

Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women

2016 ◽  
Vol 26 (5) ◽  
pp. 984-990 ◽  
Author(s):  
Antonio Braga ◽  
Valéria Moraes ◽  
Izildinha Maestá ◽  
Joffre Amim Júnior ◽  
Jorge de Rezende-Filho ◽  
...  
Keyword(s):  
Natural History ◽  
Early Diagnosis ◽  
Clinical Symptoms ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Complete Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
History Of

ObjectiveThe aim of the study was to evaluate potential changes in the clinical, diagnostic, and therapeutic parameters of complete hydatidiform mole in the last 25 years in Brazil.MethodsA retrospective cohort study was conducted involving the analysis of 2163 medical records of patients diagnosed with complete hydatidiform mole who received treatment at the Rio de Janeiro Reference Center for Gestational Trophoblastic Disease between January 1988 and December 2012. For the statistical analysis of the natural history of the patients with complete molar pregnancies, time series were evaluated using the Cox-Stuart test and adjusted by linear regression models.ResultsA downward linear temporal trend was observed for gestational age of complete hydatidiform mole at diagnosis, which is also reflected in the reduced occurrence of vaginal bleeding, hyperemesis and pre-eclampsia. We also observed an increase in the use of uterine vacuum aspiration to treat molar pregnancy. Although the duration of postmolar follow-up was found to decline, this was not accompanied by any alteration in the time to remission of the disease or its progression to gestational trophoblastic neoplasia.ConclusionsEarly diagnosis of complete hydatidiform mole has altered the natural history of molar pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.

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