Caesarean scar ectopic pregnancy masquerading as gestational trophoblastic disease

Abstract

Cesarean scar ectopic pregnancy (CSEP) is a very rare form of ectopic pregnancy in which implantation occurs at the site of the previous cesarean scar with low or absent beta-human chorionic gonadotropin (hCG) levels. It has various differential diagnoses on gross and microscopic examination. A delay in the identification and management of this condition may lead to life-threatening complications. Here, we discuss the incidence and clinicopathological features of chronic CSEP, its types, and differential diagnoses.

Exaggerated placental site in a cesarean scar: Misdiagnosed as gestational trophoblastic neoplasia: A case report

“…Thus, although hysteroscopic removal is used as an effective treatment, CSPs may occasionally be associated with complications due to continuous growth of the retained tissue ( 8 ). It was reported that 3.3% of GTNs are located in cesarean scars ( 9 ), with rare case reports on choriocarcinomas, PSTTs and ETTs and a high rate of misdiagnosis ( 10 ). Indeed, it is crucial but challenging to make an acute diagnosis of GTN and tumor-like lesions by histology ( 10 ).…”

“…It was reported that 3.3% of GTNs are located in cesarean scars ( 9 ), with rare case reports on choriocarcinomas, PSTTs and ETTs and a high rate of misdiagnosis ( 10 ). Indeed, it is crucial but challenging to make an acute diagnosis of GTN and tumor-like lesions by histology ( 10 ). For CSP choriocarcinoma, misdiagnosis can result in delayed treatment or even tumor metastasis ( 2 ).…”

“…By contrast, there is no specific treatment for EPS, although follow-up of β-hCG levels is necessary. EPS may also be present in women with CSP and there are very few reports describing the clinical course of EPS ( 10 , 11 ). The pathogenesis of EPS has not been clearly determined.…”

Methotrexate treatment of very high β-HCG ectopic pregnancy on previous cesarean scar: A case report

“…Furthermore, these pregnancies can occur on myomectomy scars [1] . The displacement of the embryo in CSP is thought to be caused by either a fistula inside the scar tissue or a structural defect in the lower part of the uterus [2] . As women with CSP are more likely to experience uterine rupture, bleeding, hysterectomy, and loss of fertility, an early and precise diagnosis is essential.…”