Heterogenous Presentation of Chorioadenoma Destruens

Abstract

Invasive mole also known as chorioadenoma destruens comprises about 15 % of all gestational trophoblastic neoplasia [1]. It is a trophoblastic tumor characterized by myometrial invasion by direct extension or through venous channels. The most common presenting symptom is vaginal bleeding (97 %) [2]. The diagnosis is usually suggested after a hydatidiform mole is removed and βhCG remains elevated and there is no evidence of metastasis. We had an opportunity to see four women with unusual presentations. Presenting as Ruptured Ectopic Pregnancy A 32-year-old female presented in a state of shock with a history of amenorrhea for 2 months, bleeding per vaginum and pain in the abdomen for the past 6–8 h. She was third gravida with LCB 12 years ago and H/O spontaneous first trimester abortion 2 months ago. Her general condition was very poor with marked pallor, tachycardia, and hypotension. There was generalized rigidity and tenderness all over the abdomen. On per vaginal examination, cervical movements were tender and the exact size of the uterus could not be assessed. The patient was immediately resuscitated and taken for exploratory laparotomy with a provisional diagnosis of ruptured ectopic pregnancy. On opening the abdomen, 1.5–2 l of blood was removed from the peritoneal cavity. The uterus was enlarged, soft, and about 12–14 weeks in size. There was a rupture at the right cornu with multiple vesicles seen protruding from the site, suggestive of a perforating hydatidiform mole involving a large area (as shown in Fig. 1). Both the tubes and ovaries were found to be normal. The decision for total abdominal hysterectomy was taken. Her baseline βhCG titer was 20,372 miu/ml and her liver function tests, renal function tests, thyroid function tests, and X-ray chest were within normal limits. The uterine specimen was sent for histopathologic examination and it was reported as an invasive mole. Her βhCG came to normal after two courses of methotrexate given at an interval of 14 days. She is under follow-up. Open in a separate window Fig. 1 Showing rupture at the right cornu with multiple vesicles seen protruding out