Obstet Gynecol Sci.  2016 Nov;59(6):548-553. 10.5468/ogs.2016.59.6.548.

Giant invasive mole presenting as a cause of abdominopelvic mass in a perimenopausal woman: An unusual presentation of a rare pathology

• Akyol A
• SimÅŸek M
• Üçer O

• KMID: 2378583
• DOI: http://doi.org/10.5468/ogs.2016.59.6.548

Abstract

Invasive mole is a benign gestational trophoblastic disease that arises from the myometrial invasion of any gestational event via direct extension through tissue or vascular structures. Invasive mole (and other gestational trophoblastic diseases) may present with life-threatening complications including uterine perforation, excessive bleeding, acute hemoperitoneum, and abdominal pain. We report a case of invasive mole presenting as abdominal distention in a 51-year-old perimenopausal woman (gravida 12, para 12, abortion 0). The patient was admitted to the gynecology clinic with a giant uterine mass filling the pelvic and abdominal cavity. To our knowledge, this is the first case in the literature of a gestational trophoblastic neoplasia presenting with uterine mass of 28 weeks' gestational size in this age group. Interestingly, complications such as uterine rupture or invasion of the adjacent structures (such as parametrial tissues or blood vessels) had not developed in our patient despite the considerable enlargement of the uterus.

Keyword

Gestational trophoblastic disease; Hydatidiform mole, invasive mole; Hysterectomy

MeSH Terms

Abdominal Cavity
Abdominal Pain
Female
Gestational Trophoblastic Disease
Gynecology
Hemoperitoneum
Hemorrhage
Humans
Hydatidiform Mole, Invasive*
Hysterectomy
Middle Aged
Pathology*
Pregnancy
Trophoblasts
Uterine Perforation
Uterine Rupture
Uterus

Figure

• 

  Fig. 1 (A) Giant invasive mole (28×25×15 cm) presenting with abdominopelvic mass. (B) Ultrasound images show a huge molar mass and marked thinning of the uterine wall. (C) The preoperative pulmonary computed tomography scan revealed metastatic nodules (white arrow), especially in basal segments of the right lung. (D) All of the nodules showed significant regression at 12th month after chemotherapy.

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  Fig. 2 (A) Distended hydropic villi and trophoblastic cells which invade into the adjacent myometrium (hematoxylin-eosin, ×40). (B) Lymphatic vessels with immunostaining of CD31 (immunoperoxidase, ×100).

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