Rare Case of a Young Female With Co-existent Hydatidiform Mole and Pulmonary Metastases: An Underrecognized Entity

Abstract

Gestational trophoblastic disease (GTD) comprises placental-site hydatidiform moles, invasive moles, or choriocarcinoma which are of unknown etiology and characterized by abnormal proliferation of gestational trophoblastic tissue. Furthermore, malignant GTD is also characterized by hematogenous spread to distant metastatic sites. Nevertheless, early diagnosis of gestational trophoblastic disease is important to ensure timely and successful management of the clinical condition and for the preservation of fertility. We report the unusual case of a complete hydatidiform mole to pulmonary metastases in a 27-year-old woman with elevated beta-human chorionic gonadotropin (β-hCG) levels. The placental histopathology showed a complete hydatidiform mole with absent fetal parts. Beta-human chorionic gonadotrophin (β-hCG) levels were found elevated at 893 mIU/mL. The case was discussed at the multidisciplinary tumour board and surgical resection with four cycles of combination chemotherapy was recommended, following which β-hCG normalization was achieved. This case report highlights the importance of clinical vigilance even in low-risk patients. Unexpected findings on ultrasound should involve multidisciplinary input from radiologists and surgical oncologists. A high index of suspicion for gestational trophoblastic disease and imaging follow-up for metastases is imperative.

Keywords: beta-human chorionic gonadotrophin levels; combination chemotherapy; gestational trophoblastic disease; hydatidiform mole; pulmonary metastases.

Figure 1. Transverse ultrasonography image demonstrating a heterogeneous intrauterine mass containing multiple cystic spaces. Note the absent fetal parts with an associated snow-storm appearance consistent with features of complete molar pregnancy.

Figure 2. Color Doppler ultrasonography image demonstrating no vascularity within intrauterine mass with cystic spaces.

Figure 3. CECT of chest demonstrating metastatic lesions (arrows) in bilateral lungs with nodular and irregular interlobular septal thickening consistent with features of lymphangitis carcinomatosa.

CECT: contrast-enhanced computed tomography.

Figure 4. Histopathology image of the evacuated specimen demonstrating trophoblastic proliferation (hollow black arrows) and hydropic degeneration of villi (solid green arrows) consistent with features of molar pregnancy (H and E, ×400).