Invasive mole with a living intrauterine pregnancy: A case report with literature review

Invasive mole is a subset of gestational trophoblastic neoplasia that exhibits myometrial invasion following a molar pregnancy. Its occurrence alongside a living intrauterine pregnancy is extremely rare and clinically challenging, carrying a high risk of morbidity and mortality. A 35-year-old multiparous woman (G7P6-1) presented at 11 weeks of gestation with irregular vaginal bleeding and nausea. Transvaginal ultrasound and magnetic resonance imaging demonstrated a living fetus with cardiac activity, with a large heterogeneous subchorionic mass and focal thinning at the site of a previous cesarean scar. Despite the viable pregnancy, serum β-hCG levels were markedly elevated. One week after initial evaluation, the patient developed massive hemorrhage necessitating an emergency total abdominal hysterectomy as a life-saving intervention. Histopathological analysis confirmed an invasive molar pregnancy coexisting with a living fetus with cardiac activity. Postoperatively, β-hCG levels declined significantly, and the patient remains under close follow-up. A literature review identified six reported cases of invasive mole with coexisting pregnancy, most following complete hydatidiform moles, although such cases may develop after any gestational event. Vaginal bleeding was the most frequent symptom, and ultrasonography aided diagnosis in all cases. β-hCG levels exceeding 100,000 mIU/mL were reported in four cases. Management strategies are individualized, ranging from single-agent chemotherapy for low-risk disease to hysterectomy in those with uncontrolled bleeding or completed childbearing. Invasive mole with a living intrauterine pregnancy poses a serious threat to maternal health, emphasizing the need for prompt multidisciplinary evaluation and readiness for emergency surgical intervention.