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Published on: October 20, 2019
Rupture of interstitial ectopic pregnancy secondary to invasive hydatidiform mole with pelvic metastasis in
1Department of Gynaecology and Obstetrics, Ya'an People's Hospital, Ya'an, Sichuan Province, People's Republic of China.
Rationale:
Ectopic gestational trophoblastic disease is an extremely rare subtype of gestational trophoblastic disease, with perimenopausal cases especially scarce and prone to preoperative misdiagnosis as a common ectopic pregnancy, leading to potential delays in proper management.
Patient Concerns:
A 50-year-old perimenopausal woman (G6P2) presented with acute abdominal pain, dizziness, profuse sweating, and hemorrhagic shock. She had a 4-month amenorrhea, a history of ectopic pregnancy surgery, and uterine curettage. Preoperative assessment suggested ectopic pregnancy rupture with massive intra-abdominal hemorrhage, without initial suspicion of trophoblastic neoplasia.
Diagnoses:
Emergency laparoscopic surgery and pathological examination confirmed interstitial ectopic pregnancy rupture secondary to invasive hydatidiform mole with pelvic soft tissue invasion. International Federation of Gynecology and Obstetrics stage II, World Health Organization prognostic score 10 (intermediate-high risk).
Interventions:
Emergency laparoscopic wedge resection of the left uterine horn lesion, uterine reconstruction, and bilateral uterine artery ligation were performed. Postoperative standardized etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine chemotherapy was administered, followed by 3 cycles of consolidation chemotherapy after beta-human chorionic gonadotropin (β-hCG) normalization.
Outcomes:
Serum β-hCG returned to normal at 8 weeks postoperatively. No severe chemotherapy adverse reactions occurred. No recurrence was detected during regular follow-up.
Lessons:
Perimenopausal women with amenorrhea, acute abdominal pain, and extremely elevated β-hCG (>105 IU/L) should raise a strong suspicion of ectopic gestational trophoblastic disease. Integrated clinical, imaging, laboratory, and pathological evaluation reduces misdiagnosis. Surgical lesion resection combined with standardized etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine chemotherapy, and close follow-up yields a favorable prognosis.
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