First Case of Mole in the Horn

Abstract

A 31-year-old (G3P1L0A1 [gravida 3, para1, living 0, abortion1]) woman presented with a molar pregnancy in the rudimentary horn of a unicornuate uterus. Magnetic resonance imaging was consistent with a molar pregnancy in the rudimentary left horn. Her beta–human chorionic gonadotropin (hCG) to 38,000 mIU/ml the next day and 1,100mIU/ml after 1 week. Hysteroscopy revealed a single cervix with a tubular cavity. The right ostium was clearly visualized (Fig. 1A). The left ostium was not seen. Just beyond the internal os on the left side, an opening was seen, which could have been the communication with the left horn (Fig. 1B). Laparoscopy revealed a unicornuate uterus with a 5 × 5 cm left rudimentary horn (Fig. 2A). The bilateral tubes and ovaries were normal. Rudimentary horn excision was performed (Figs. 2B-D). The specimen was retrieved within an indigenous glove endobag by mechanical morcellation through extension of the left lateral port. There was no spillage. The specimen showed multiple vesicles (Fig. 3A). The patient's beta-hCG dropped to 38,000 the next day and 1,100 after 1 week. It was not detectable after 4 weeks. Histopathological examination of the specimen showed a complete mole (Fig. 3B). She was followed up for 6 months with beta-hCG, which was not detectable. The present case is the first case of a molar pregnancy in the rudimentary horn managed by laparoscopic hemihysterectomy. Endobag retrieval is important without any spillage in the peritoneal cavity or the port site. Follow-up is essential to detect rising or plateauing of beta-hCG, which could indicate gestational trophoblastic neoplasia. Fig. 2Laparoscopy. (A) The unicornuate uterus with a left rudimentary horn. (B) The left round ligament, mesosalpinx, and ovarian ligament cauterized and cut. (D) The uterus with the bilateral ovaries at the end of the procedure. (C) The fibromuscular stalk cauterized and cut. View Large Image Figure Viewer Download Hi-res image Fig. 3(A) Vesicles within the horn. (B) Villus distended with stromal fluid and cistern formation (trophoblastic proliferation). View Large Image Figure Viewer Download Hi-res image