Primary Tubal Choriocarcinoma Presented as Ruptured Ectopic Pregnancy

Abstract

The primary tubal choriocarcinoma associated with ectopic pregnancy is very rare. A 31-year-old woman was admitted to the emergency room due to amenorrhea, left lower abdominal pain and fatigue. Her β-Hcg level was 29251.4 mIU/ml and transvaginal ultrasund revealed a 24x21 mm of left tubal ectopic pregancy mass with large amount of free fluid in pelvic cavity. The patient was diagnosed with ruptured tubal ectopic pregnancy and thus, she underwent laparotomy with left total salpingectomy. The pathological assessment was reported as primary tubal choriocarcinoma with the involvement of whole tubal layer. The patient was defined to have stage I choriocarcinoma with good prognostic factors and methotrexate monotherapy was administered. Serum β- Hcg levels of the patient gradually declined and eventually became negative at the first month of the treatment. With this case report we aimed to implicate that when diagnosing the ectopic pregnancy, even very rare, the tubal choriocarcinoma should be kept in mind.

Keywords: Human chorionic gonadotropin; Tubal pregnancy; Tubal rupture.

[Table/Fig-1]:

Intraoperative view of left tubal mass measuring 4x3 cm between two fingers of the operator

[Table/Fig-2]:

Postoperative macroscopic view of left salpingectomy material

[Table/Fig-3]:

Histopathologic view of tubal choriocarcinoma presenting the biphasic feature of mixed atypical cytotrophoblasts and syncytiotrophoblasts