A Rare Case of Ectocervical Pregnancy and Its Successful Management: A Case Report and Review of the Literature

Abstract

Cervical pregnancy is a very rare form of ectopic pregnancy, which can be life-threatening due to the potential risk of massive haemorrhage. The most likely site of cervical implantation is within the endocervical canal. We report here an unusual and another possible site of cervical pregnancy on the surface of the ectocervix (portio). The patient presented with vaginal bleeding after a period of six weeks of amenorrhea and a positive urinary pregnancy test. Clinical examination was suggestive of a cervical mass on the surface of the portio, which was successfully managed by local excision and the application of haemostatic sutures. Histopathology of the mass was suggestive of trophoblasts amidst cervical epithelium and stroma, which was cytokeratin positive in immunohistochemical staining, confirming the diagnosis of cervical ectopic pregnancy on the portio. Postoperatively, the patient recovered well and beta-human chorionic gonadotropin (βhCG) normalised within two weeks. Thus, the surface of the ectocervix is another possible site of cervical pregnancy, which can be successfully managed by total excision of the ectopic mass and local haemostatic measures.

Keywords: conservative management; ectocervical pregnancy; ectopic pregnancy; methotrexate; surgical excision.

Figure 1. Fleshy mass at 10 to 11 o'clock position on the ectocervix.

Figure 2. Ectocervical mass excised completely.

Figure 3. Haemostatic sutures applied to control bleeding from the excision site.

Figure 4. Histopathology of the cervical mass showing intermediate trophoblasts in a background of cervical epithelium and stroma (hematoxylin and eosin stain, original magnification x40).