Partial mole in ectopic pregnancy

Abstract

Objective: To evaluate the incidence of molar pregnancy in the fallopian tube pregnancy. Setting: Outpatient clinic. Patient: 32-year-old Asian woman. Intervention: Left salpingectomy. Outcome: Molar ectopic pregnancy. Result: Ectopic partial mole pregnancy. Conclusion: Molar pregnancy can occur in ectopic pregnancy. Clinically, molar pregnancy mimics normal tubal ectopic pregnancy.Keywords Tubal ectopic pregnancy . Molar pregnancy Case reportA 32-year-old Asian woman with four children was referred to the early pregnancy unit in January 2005. She was 11 weeks pregnant and was having vaginal bleeding that had started 7 days before admission and had included the passing of clots, which had settled. She had no associated pelvic or shoulder pain. Her past medical and surgical history was not significant. She was not a smoker and had no allergies.On examination her pulse was 88, blood pressure 120/68, and temperature 36.9ºC. High vaginal and chlamydia swabs were taken. The chest examination was clear, and the heart examination showed S1, S2. Abdominal examination showed tenderness over the left iliac fossa with no guarding or rigidity. The vulva was smeared with blood, and there was brown blood in the vagina. Internal examination revealed a bulky anteverted uterus with no adnexal masses. No tenderness over the pelvic area or cervical excitation could be identified.The pregnancy test in the hospital was positive. An ultrasound scan was arranged, which showed a bulky anteverted uterus with thin (4 mm) endometrium. No evidence of intrauterine pregnancy was seen, and both ovaries appeared normal. In the left adnexa there was a 44×25×38-mm complex mass. It appeared to be in the fallopian tube, and there was also a hydrosalpinx at the medial section. No free fluid was identified. The findings were consistent with ectopic pregnancy. The patient's beta human chorionic gonadotropin (BHCG) level on the day of admission was 12,894 U/l, and her haemoglobin level was 13 g/dl. She was RH-positive.A diagnosis of left tubal pregnancy was made, and the patient was prepared for surgery on the same day of admission. She was grouped and saved, and a diagnostic laparoscopy was done. Both ovaries and the right tube were normal, but a left tubal pregnancy could be seen actively bleeding in the tube. Laparotomy was performed, and the laparoscopic findings were confirmed. The left tube was found to be ruptured. A left salpingectomy was done and the specimen sent to histopathology. The patient recovered uneventfully and was discharged home on the 3rd day after admission. Her haemoglobin level on discharge was 10.3 g/dl. The swab results came back positive only for Candida, and the patient's general practitioner was informed.The histopathology report suggested partial hydatidiform mole of ectopic pregnancy (Fig. 1). Therefore, the patient was notified to be seen in the gynaecology clinic 6 weeks from the procedure for follow-up of the partial molar pregnancy. She was advised to refrain from getting pregnant until her HCG levels had been normal...

Ectopic tubal pregnancy with partial mole: A rare entity with review of literature

“…All surgically managed ectopic pregnancy cases must be submitted for histopathological examination. 4 Microscopically complete moles are characterized by hydropic change in all villi associated with cistern formation, stromal karyorrhexis, vacuolization of syncytiotrophoblast and cytoptrophoblastic proliferation. There is no intraluminal nucleated fetal RBCs.…”

“…In difficult cases DNA flow cytometry for ploidy examination and P57 KIP2 immunocytochemical marker are useful. 4,5 The risk of persistent trophoblastic disease in tubal molar pregnancy is equivalent to that in uterine molar pregnancy, 0.5% in partial mole and 15% in complete mole. 4 With regard to other trophoblastic disorders, the prognosis of tubal choriocarcinoma is better than uterine choriocarcinoma.…”

“…4,5 The risk of persistent trophoblastic disease in tubal molar pregnancy is equivalent to that in uterine molar pregnancy, 0.5% in partial mole and 15% in complete mole. 4 With regard to other trophoblastic disorders, the prognosis of tubal choriocarcinoma is better than uterine choriocarcinoma. 4 Cases of tubal choriocarcinoma with metastasis also respond well to treatment and achieve sustained remission.…”

“…4 With regard to other trophoblastic disorders, the prognosis of tubal choriocarcinoma is better than uterine choriocarcinoma. 4 Cases of tubal choriocarcinoma with metastasis also respond well to treatment and achieve sustained remission. 2 In literature a case of pulmonary metastasis from tubal molar pregnancy has also been mentioned.…”

Case of post tubectomy tubal partial molar pregnancy

“…This may be associated with sheets of pleomorphic extravillus trophoblast fragments. 7 The extravillus trophoblastic proliferation may appear more florid in ectopic molar pregnancy than in molar pregnancy confined to uterus. Adherence to strict criteria regarding morphologic abnormalities are a must for diagnosis of molar pregnancy.…”