Distinguishing between intramural pregnancy and choriocarcinoma: A case report

Abstract

Intramural pregnancy is a rare type of ectopic pregnancy with an unclear etiology. It may be associated with uterine wall injury and/or abnormal uterine conditions, such as adenomyosis, in certain cases. In the present report, a case of intramural pregnancy associated with adenomyosis is discussed. The patient was 34 years old and presented with amenorrhea for 40 days. Ultrasonography and magnetic resonance imaging revealed a mixed echogenic mass located within the posterior wall of the uterine fundus with abundant blood flow. In addition, the patient's β-human chorionic gonadotropin levels were markedly elevated; however, these levels demonstrated a declining tendency. Clinically, it was difficult to distinguish the diagnosis of the case between intramural pregnancy and choriocarcinoma. Following initial treatment with methotrexate-based chemotherapy, a laparotomy was performed to confirm the diagnosis and excise the lesion. Pathological analysis confirmed a diagnosis of intramural pregnancy and adenomyosis within the uterine wall. The results of the present case report suggest that surgical intervention should be the first action performed when intramural pregnancy is suspected, in order to confirm the diagnosis and treat the disease.

Keywords: adenomyosis; choriocarcinoma; intramural ectopic pregnancy.

Figure 1.

Ultrasonographic images of the lesion. (A) Transvaginal ultrasonography revealed a solid cystic lesion completely confined to the myometrium of left uterine wall with no connection to the endometrial cavity. The black arrow indicates the gestation sac. (B) Doppler images revealed abundant perilesional vascularity.

Figure 2.

MRI images of the lesion. MRI imaging revealed a mass with (A) low signal intensity on T1WI and (B) high signal intensity on T2WI. (C) T2WI, sagittal plane. (D) T2WI, coronal plane. Arrows indicate the lesion. T1WI, T1-weighted image; T2WI, T2-weighted image; MRI, magnetic resonance imaging.

Figure 3.

Lesion appearance, schema chart and pathological section. (A) Laparotomy revealed a mass inside the left posterior lateral aspect of the uterus. (B) Image of the mass removed. (C) Schema chart of the lesion section: a, normal muscle tissue in the outer layer; b, blood clot surrounding the vesicle; and c, edematous vesicle. (D) Pathological section demonstrating villi inside the uterine wall isolated from the uterine cavity, as demonstrated by the black arrow (hematoxylin and eosin stained; magnification, ×400).