Fertility preserving treatment in a nulliparous with a molar pregnancy: a case report

Hydatidiform mole represents an abnormal form of conception that occurs in about one in 500-1000 pregnancies. It is a subtype of gestational trophoblastic disease. Hydatidiform moles should be regarded as premalignant lesions because 15-20% of complete hydatidiform moles (CHMs) and 1% of partial hydatidiform moles (PHMs) undergo malignant transformation into invasive moles, choriocarcinomas, or, in rare cases, placental-site trophoblastic tumors (PSTTs). We will illustrate the case of a 26-year-old nulliparous with a seven weeks amenorrhea, positive immunological pregnancy test, a β-HCG value of 136 000 mIU÷mL and minor vaginal bleeding. The ultrasonographic examination showed an enlarged endometrium with adjacent hyperechoic material containing tiny anechoic spaces and an anembryonic pregnancy, distended endometrial cavity containing innumerable, variably sized anechoic cysts with intervening hyperechoic material ("snowstorm" appearance). The CT showed a uterine mass measuring 89÷111÷67 mm, inhomogeneous density, proliferative-infiltrative endocavitary tissue without exceeding the peritoneal serosa, and a few pulmonary micronodules with not certain origin on the left inferior lobe. In this case, due to the large infiltrative uterine mass, the risk of severe bleeding after curettage and the possibility of a necessity hysterectomy, we decided to apply first of all the Methotrexate protocol for molar pregnancy.