A 32-year-old female with obstetric score of G3P2L2 came to obstetric outpatient department with complaints of amenorrhea since one and half months, pain abdomen and spotting per vaginum since one day. There were no complaints of vomiting or febrile illness. Past obstetric history was normal. Urine pregnancy test was done and was positive. Clinical examination revealed soft abdomen with mild tenderness in the hypogastrium and right iliac fossa. Per vaginal examination revealed bulky uterus and right cervical tenderness was positive. There was no evidence of mass lesion. Ultrasonography of the pelvis showed right adnexal mass 4x3cm adjacent to right ovary and uterus height was corresponding to 5weeks 1 day. Haemoperitoneum with minimal fluid was noted in Morison's pouch. Routine haematological and biochemical examinations were within normal limits. Explorative laprotomy was performed. Intraoperatively, there was ruptured right tubal mass measuring 3x2 cm with moderate haemoperitoneum. Right salphingectomy was done. The specimen was sent for histopathological evaluation. The right fallopian tube measured 4cm in length and was dilated and ruptured near fimbrial end. Two tiny parafimbrial cyst seen each measuring <0.5 cm. Cut surface along the dilated segment of the fallopian tube showed thinned out wall and the lumen contained blood clot with pale glistening tiny cyst (m) <0.5 cm [Table/ Fig-1].Histological examination revealed ruptured fallopian tube. The lumen contained blood clot with branching, avascular villi with marked edematous stroma. Proliferation of cytotrophoblast and syncitiotrophoblast was seen with moderate degree of atypia. The villous structures were seen penetrating the muscularis layer of fallopian tube along with haemorrhage [Table/ Fig-2].The patient was followed weekly quantitative beta HCG titers until three successive beta HCG levels were negative (HCG<5mI u/ml). The Beta HCG values were 134 mIU/ml, 4.19 mIU/ml and 2.68 mIU/ml consecutively. DISCUSSIONEctopic gestation is a common phenomenon with an incidence rate of 4.5-16.8/1000 pregnancies. Tubal ectopic hydatidiform moles are quiet rare lesions, and 132 cases have been reported in the world literature [1]. GTD can be preceded by any type of pregnancy, including a term pregnancy, abortion, molar gestation, or rarely by tubal gestation. The median maternal age is 31 (range, 15-54) years and median gestational age is10 (range, 5-27) weeks [2]. Hydatidiform moles occurs due to a placental malformation; due to genetic aberration of the villous trophoblast. This is characterized by cystic swelling and trophoblastic proliferation. Molar gestation commonly develops within the uterus but may also occur in sites of ectopic pregnancy [3]. ABSTRACTThe incidence of hydatidiform mole is 1 per 1000 pregnancies. The occurrence of hydatidiform mole in ruptured tubal pregnancy is very rare. We report an unusual case of molar pregnancy in the right fallopian tube which presented as an adherent adnexal mass. The present case conveys the importance of histo...
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