Ruptured large ectopic hydatidiform mole: an infrequent presentation of gestational trophoblastic disease

Abstract

Gestational trophoblastic disease (GTD) comprises hydatidiform mole, invasive mole, epithelioid trophoblastic tumor, placental site trophoblastic tumor, and choriocarcinoma. Ectopic molar gestation (EMG) is exceedingly rare with similar malignant potential like that of an intrauterine molar pregnancy. We report an uncommon case of EMG diagnosed by ultrasonography (USG) with a brief literature review. A 36-year-multipara presented at 8-weeks gestational age with severe abdominal pain and spotting. She underwent a spontaneous abortion 4 months back. Current transabdominal USG revealed a large right adnexal hydatidiform mole with moderate hemoperitoneum. Right ovary could not be discerned separately. Emergency laparotomy with hysterectomy and right adnexal clearance was done. Histopathology showed complete ectopic hydatidiform mole. USG remains the modality of choice for initial assessment of suspected GTD and it allows reliable evaluation of residual or recurrent disease. This report emphasizes the role of USG in the diagnosis of EMG and also, the importance of including EMG in the differential diagnosis of suspected ectopic pregnancy.

Keywords: Complete mole; Ectopic molar gestation; Gestational trophoblastic disease; Hydatidiform mole; Molar pregnancy.

Fig. 1

Right adnexal ectopic hydatidiform mole. a–d Transabdominal ultrasonography (USG) images. a Bulky uterus without intrauterine gestational sac. b Large right adnexal multicystic heteroehoic mass (arrow) s/o ectopic hydatidiform mole. c Left adnexa showing normal left ovary (dotted arrow). Asterisk (*) shows hemoperitoneum. d Hemoperitoneum (*) seen as intraperitoneal hyperechoic free fluid in the hepatorenal pouch

Fig. 2

Per-operative image showing multicystic right adnexal mass (arrow)

Fig. 3

Histopathology images. a and b Hematoxylin and eosin (H&E) staining of the tissue sample. a 10× magnification: irregular‐shaped villus showing circumferentially proliferated trophoblast cells with enriched stroma. b 40× magnification: edematous villus with central cistern (hydropic appearance)