Partial Hydatidiform Mole, Finding in an Ectopic Tubal Pregnancy: A Case Report

The ectopic molar pregnancy is rare pathology, with anatomopathological diagnosis. Management and follow-up are similar to algorithm of molar pregnancy intrauterus.

The gestational trophoblastic disease has the origin in the abnormal proliferation of trophoblast. One of the subgroup are the hydatidiform mole, which is the result of an anomaly in fertilization and they could have the potential to invade the uterus and even to metastasize [1].
But, could the hydatidiform mole established in other different site from uterus? We present a retrospective medical review of a single case [2,3].
A 34-year-old primiparous women suffered acute onset lower abdominal pain for which she consulted in the emergency department. She was otherwise healthy with no medical problems or any past surgical history. The patient had a positive urine pregnancy test with 7 ? 5 weeks of amenorrhea.
On presentation, she was hemodynamically stable. The peritoneal irritation stressed in the exploration report, with vaginal bleeding absence. Transvaginal ultrasound demonstrated a extrauterine pregnancy in left adnexal area: gestational sac with active heartbeats and body motions, embryo of 17 mm (gestational age of 8 weeks), moderate hemoperitoneum and no evidence of intrauterine pregnancy.
The patient underwent laparoscopic left salpingectomy, previously finding hemoperitoneum and left tubal mass as a ectopic pregnancy.
The anatomopathological examination described a ectopic tubal pregnancy with discoveries of partial hydatidiform mole (Fig. 1). On the basis of this diagnosis, the patient was referred to Gynecologic Oncology for further management.
The hCG monitoring demonstrated a decrease, we found 253 mIU/ml 15 days after surgery, with negative results in 4 weeks. The radiologic control, based on the protocol in our hospital, was negative for the metastatic disease.
After the pathology, the patient have not had clinical symptoms, and she continued with negative result during 6 months of follow-up. Consequently, she was discharged.
In conclusion, the ectopic molar pregnancy is infrequent, which diagnosis is essentially an anatomopathological study. Management and follow-up are similar to algorithm of molar pregnancy intrauterus.
Furthermore, we should also reflect about the infradiagnosis of cases with metrotexate treatment, where the histological study would not be practicable and all the related implications regarding about the management.
At the present time, there is not analysis or complementary test to differentiate between ectopic pregnancy and tubal gestational trophoblastic disease. It is important to publish the exceptional cases such as the current study, to enhance the management of this pathology.
Funding Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature.

Declarations
Conflict of interest The authors declare that they have nothing to disclose.
Informed consent Consent was obtained by the participant in this study.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons. org/licenses/by/4.0/. Fig. 1 Histopathology images from laparoscopic salpingectomy. A Histological examination of partial hydatidiform mole 9 4, H-E Enlarged villi with extensive stromal edema and trophoblastic hyperplasia. B Fallopian tube parenchyma with hemorrhage and edema 9 4, H-E Chorionic villi are present on the right side of the photograph