Invasive mole is a rare subgroup of gestational trophoblastic disease characterized by the invasion of molar tissue into the myometrium or uterine vasculature. In this paper, we report the third case of invasive mole described in the Malagasy literature. A 33-year-old woman was referred to the Soavinandriana Hospital, her complaint was persistent vaginal bleeding during 2 months, occurring at 3 months of pregnancy with biological anemia without hemodynamic repercussions. The human chorionic gonadotropin (HCG) level was 385,931 mIU/ml. A haemostasis hysterectomy was performed. Histological examination showed an enlarged uterus and endometrial cavity containing edematous chorionic villi with trophoblastic proliferation invading the myometrium. The diagnosis was an invasive mole, stage I, FIGO score 6. Chemotherapy was prescribed but was not honored. After 45 days of follow-up, the serum βHCG level decreased to 1803 mIU/ml, without clinical symptoms. The patient then lost sight. Persistent vaginal bleeding after pregnancy may be the only clinical symptom of an invasive mole and should raise suspicion. Histological examination establishes the diagnosis. As this is an unusual cause of vaginal bleeding, our case should remind physicians that when faced with this symptom, the possibility of an invasive mole should be considered in order to make an early diagnosis for less aggressive treatment.
Ovarian goiter is a form of single tissue teratoma of the ovary, accounting for 2% -3% of mature ovarian teratomas. Malignant transformation may occur in rare cases. Papillary thyroid-type carcinoma represents the most common type of malignant struma ovarii, followed by follicular carcinoma. Malignant struma ovarii is commonly seen in women in the fifth decade. The diagnosis is often made post-operatively after histological examination. Histology also helps assess tumor aggressiveness (mitoses, necrosis, poorly differentiated subtype, etc.). Given the rarity of these lesions, no therapeutic consensus or prognostic value had yet been formally established. We report herein, the case of a 76-year-old woman with a cystic tumor of the right ovary and a nodular lesion of the bladder. The clinical symptomatology is nonspecific, associating abdomino-pelvic pain and a right latero-uterine mass on abdominal palpation. After total hysterectomy with bilateral adnexectomy, the diagnosis of papillary carcinoma arising from struma ovarii and extending into the bladder was made. Through this observation, we suggest to discuss the anatomoclinical particularities of this rare pathological entity.
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