Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects

Abstract

This report presents the case of a patient with gestational trophoblastic neoplasia after a partial hydatidiform mole formed in the Fallopian tube. Ectopic molar pregnancy is a rare condition, with an estimated incidence of 1 in every 20,000 to 100,000 pregnancies; less than 300 cases of it have been reported in the Western literature. The present report is important because it presents current diagnostic criteria for this rare condition, which has been incorrectly diagnosed in the past, not only morphologically but also immunohistochemically. It also draws the attention of obstetricians to the occurrence of ectopic molar pregnancy, which tends to progress to Fallopian tube rupture more often than in cases of ectopic non-molar pregnancy. Progression to gestational trophoblastic neoplasia ensures that patients with ectopic molar pregnancy must undergo postmolar monitoring, which must be just as thorough as that of patients with intrauterine hydatidiform moles, even if chemotherapy results in high cure rates.

Histological Study of Molar Pregnancy by using some of the Special Stains

“…The cases of partial hydatidiform mole showed scattered hydropic villi with irregular scalloped villous outlines and mild trophoblastic hyperplasia in the sections stained with hematoxyline and Eosin as it's appear in Figure (1) and this results was agree with many previous studies [14]. The partial hydatidiform mole examination of trophoblastic distribution elucidate that the majority (60%) of samples show zonal distribution and high percentage (73.3%) of focal trophoblastic proliferation as it's describe in Table (2) and that was agree with many studies [2][3][4][5][6][7][8][9][10][11]. The vessels in the villous stroma of most of partial molar samples (80%) was obviously seen also the cistern appear clearly in 73.33% of the samples which was accordant to many studies [2-5-8-11].All partial molar pregnancy samples showed present of fetal a part which was conform by all references.…”

“…Molar pregnancy or HM is rare and its frequency varies from a geographic area to another. The incidence in the United Kingdom (UK) is approximately 1 in 1000 pregnancy [3], and [1] in every 200 to 400pregnancy in Brazilian women; this is a 5 to10 fold higher incidence than that found in the United State of America and Europe [4][5]. The rates in Asia much higher, it's up to one in 100 pregnancies in Indonesia [6].…”

A rare case of gestational trophoblastic neoplasia following an ectopic molar pregnancy

“…We present a rare case of GTN following an ectopic molar pregnancy. Less than 300 cases of ectopic molar pregnancies have been described in Western medical journals ( López et al, 2018 ), and only a few of these patients were later diagnosed with GTN. To the best of our knowledge this is the only report of GTN following an ectopic complete molar pregnancy.…”

“…Most patients present with abdominal pain and/or vaginal bleeding, and require emergent surgical intervention for the removal of the ectopic pregnancy ( Hassadia et al, 2012 ). Ruptured ectopic molar pregnancies have been described regarding an ovarian pregnancy ( Joneborg et al, 2011 ) and tubal pregnancies ( López et al, 2018 , Siozos and Sriemevan, 2010 ).…”

“…An ectopic molar pregnancy is a rare entity, estimated to occur in 1.5:1,000,000 births ( Gillespie et al, 2004 ). The extraordinary combination of these two gynecological diagnoses – an ectopic pregnancy and a molar pregnancy – has been described in medical journals less than 300 times ( López et al, 2018 ).…”