Rapid progression from complete molar pregnancy to post-molar gestational trophoblastic neoplasia: a rare case report and literature review

Abstract

Background: Post-molar gestational trophoblastic neoplasia (pGTN) develops in about 15% to 20% of complete hydatidiform mole (CMH). Commonly, pGTN is diagnosed based on hCG monitoring following the molar evacuation. To date, no detailed information is available on how fast can pGTN develop from CHM. However, the concurrence of CHM and pGTN is extremely rare.

Case presentation: A 29-year-old woman presented to the gynecology department with irregular vaginal bleeding and an elevated hCG serum level. Both ultrasound and MRI showed heterogeneous mass in uterine cavity and myometrium. Suction evacuation was performed and histologic examination of the evacuated specimen confirmed complete hydatidiform mole. Repeated ultrasound showed significant enlargement of the myometrium mass one week after the evacuation. pGTN with prognostic score of 4 was then diagnosed and multi-agent chemotherapy regimen implemented with a good prognosis.

Conclusion: In rare cases, CMH can rapidly progress into pGTN. Imaging in combination with hCG surveillance seems to play a vital role guiding timely diagnosis and treatment in the specific condition. Low-risk gestational trophoblastic neoplasia (GTN) should be managed stratified according to the individual situation.

Keywords: complete hydatidiform mole; gestational trophoblastic disease; gestational trophoblastic tumor; hydatidiform mole; ultrasound.

Figure 1

(A) Gray-scale pelvic sonography displayed a mixed echogenic mass in the uterine cavity, partially invading the myometrium, with honeycomb like internal echoes. (B) Color Doppler showed that the mass was filled with abundant blood flow signals. (C) Spectrum of arteriovenous fistula was measured in pulsed-wave Doppler. (D) Pelvic MRI scan depicted heterogeneous mass in uterine cavity with hemorrhage, invading to the myometrium.

Figure 2

(A) Microscopic image of the evacuated mole tissues. Arrow points to moderate to severe trophoblast proliferation. (B) Immunohistochemical staining of the evacuated mole tissues identified a negative stain of p57.

Figure 3

(A) Gray-scale pelvic sonography showed a large honeycomb like mass within the uterine fundus, close to the serosa. (B) Pulsed-wave Doppler detected a high-speed, low-resistance arteriovenous fistula spectrum.