Intramyometrial ectopic pregnancy masquerading as intramural leiomyoma: a diagnostic challenge

One of the extremely rare locations for an ectopic pregnancy is myometrium. Intramyometrial ectopic pregnancy is characterised by an unusual form of implantation wherein the gestational sac is situated deep in the myometrium, separated from the endometrial cavity and fallopian tubes. It accounts for <1% of all ectopic pregnancies. The preoperative diagnosis based on ultrasound findings may mimic a degenerated leiomyoma, thereby posing further diagnostic challenges. We report a case of a woman in her late 20s presenting with abnormal uterine bleeding diagnosed ultrasonographically as posterior wall fibroid. Histopathological evaluation of the myomectomy specimen revealed chorionic villi lined by trophoblastic cells, thereby confirming the diagnosis. This case report aims to increase the awareness about the possibility of this potentially life-threatening rare entity even with normal serum beta-human chorionic gonadotropin levels.