Successful treatment of gestational trophoblastic neoplasia in the uterine cornus with laparoscopic cornuostomy and postoperative methotrexate injection

Life-threatening rupture of interstitial ectopic pregnancy: a rare presentation of metastatic invasive mole

An invasive mole is an uncommon type of gestational trophoblastic disease, and if considering its implantation in an interstitial extrauterine location, we are facing a rarer condition.There are 14 cases described of interstitial ectopic gestational trophoblastic disease. As far as we know, we present the third case of invasive mole within interstitial location, in this case with pulmonary metastases.The diagnosis of an interstitial implantation is challenging. Our patient was initially diagnosed with an intrauterine hydatidiform molar pregnancy, and a uterine aspiration was performed. Two weeks later, she presented with haemodynamical instability due to a severe haemoperitoneum. A laparotomy was immediately performed and revealed a ruptured interstitial pregnancy with molar vesicle extrusion. Besides its rarity, we highlight the clinical presentation with hypovolaemic shock due to rupture of ectopic pregnancy in a young nulliparous woman, which required an emergent surgical approach with lifesaving purpose while preserving future fertility.

Gestational trophoblastic neoplasia presenting as an interstitial ectopic pregnancy

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Gestational trophoblastic neoplasia (GTN) arising from interstitial ectopic pregnancy.

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Minimally invasive surgical management of interstitial ectopic pregnancy is feasible.

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GTN arising from interstitial ectopic pregnancies have favorable prognoses.

Gestational trophoblastic disease (GTD) is a group of benign and malignant tumors that develop from placental tissue and includes hydatidiform moles and gestational trophoblastic neoplasia (GTN). Invasive molar disease and choriocarcinoma are rare forms of GTN and can arise from any pregnancy event. An interstitial ectopic pregnancy occurs with implantation within the intramural portion of the fallopian tube covered by myometrium. We present two cases of an invasive mole with pathology consistent with choriocarcinoma in situ arising from an interstitial ectopic pregnancies. We review management strategies including a minimally invasive surgical approach. Additionally we present a review of the literature of gestational trophoblastic disease associated with interstitial ectopic pregnancies.

Genetically Related Choriocarcinoma Developing 5 Yr After a Complete Hydatidiform Mole and Simulating a Cornual Ectopic Pregnancy

Persistent gestational trophoblastic disease can arise from any type of antecedent pregnancy, including molar and tubal pregnancies. While most cases of persistent gestational trophoblastic disease present within the first year following initial diagnosis, recurrence has rarely been reported many years after initial diagnosis. Distinguishing recurrence from a new independent lesion is clinically important. A 25-yr-old woman presented with a mass in the right uterine cornu that was discontiguous with the endometrial cavity and was associated with an elevated serum human chorionic gonadotropin level. She had a history of an invasive complete hydatidiform mole with lung involvement treated with chemotherapy 5 yr prior. Wedge resection of the right cornu was performed due to concern for a cornual ectopic pregnancy. Pathologic evaluation demonstrated a choriocarcinoma. Molecular genotyping confirmed the tumor as recurrent disease genetically related to the prior complete hydatidiform mole. She completed 4 cycles of EMA-CO therapy, and has been disease-free with undetectable serum human chorionic gonadotropin level for 2 yr.