Abstract
Gestational trophoblastic disease (GTD) comprises placental-site hydatidiform moles, invasive moles, or choriocarcinoma which are of unknown etiology and characterized by abnormal proliferation of gestational trophoblastic tissue. Furthermore, malignant GTD is also characterized by hematogenous spread to distant metastatic sites. Nevertheless, early diagnosis of gestational trophoblastic disease is important to ensure timely and successful management of the clinical condition and for the preservation of fertility. We report the unusual case of a complete hydatidiform mole to pulmonary metastases in a 27-year-old woman with elevated beta-human chorionic gonadotropin (β-hCG) levels. The placental histopathology showed a complete hydatidiform mole with absent fetal parts. Beta-human chorionic gonadotrophin (β-hCG) levels were found elevated at 893 mIU/mL. The case was discussed at the multidisciplinary tumour board and surgical resection with four cycles of combination chemotherapy was recommended, following which β-hCG normalization was achieved. This case report highlights the importance of clinical vigilance even in low-risk patients. Unexpected findings on ultrasound should involve multidisciplinary input from radiologists and surgical oncologists. A high index of suspicion for gestational trophoblastic disease and imaging follow-up for metastases is imperative.
Highlights
The spectrum of clinical entities ranging from benign forms such as hydatidiform mole to malignant forms such as choriocarcinoma comprises gestational trophoblastic disease (GTD)
We report the unusual case of a complete hydatidiform mole to pulmonary metastases in a 27-year-old woman with elevated beta-human chorionic gonadotropin (β-hCG) levels
Currently surgical resection of pulmonary metastatic lesions is reserved for relapsed lesions or new-onset lesions of metastatic pulmonary disease with co-existent gestational trophoblastic disease [14]. This case report deserves special mention as it highlights the importance of timely management in patients with hydatidiform mole which might require chemotherapy and/or surgical resection when there is the concomitant occurrence of pulmonary metastases which is truly an underrecognized entity
Summary
The spectrum of clinical entities ranging from benign forms such as hydatidiform mole to malignant forms such as choriocarcinoma comprises gestational trophoblastic disease (GTD). Chemotherapeutic regimens with methotrexate have been recommended for the management of molar pregnancies, such as partial and complete hydatidiform moles [1]. Following the diagnosis of hydatidiform mole, evacuation of the molar pregnancy should be performed at the earliest to minimize the risk of hematogenous metastases. Complete hydatidiform mole is a benign form of gestational trophoblastic disease with an extremely rare incidence of pulmonary metastases. We report the unusual case of a complete hydatidiform mole to pulmonary metastases in a 27-year-old woman with elevated beta-human chorionic gonadotropin (β-hCG) levels. A 27-year-old nulliparous woman presented with progressive lower abdominal pain since 10 days and occasional hemoptysis since two months She was referred to the department of obstetrics for further evaluation after her urine pregnancy test showed positivity and her last menstrual period was 19+4 weeks prior to presentation.
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