Fig. 19.1
Massive peritubal hemorrhage and large elongated chorionic villi displaying hyperplastic trophoblast (a), and cysterns with trophoblastic proliferation (b). Stroma exhibits prominent karyorrhexis (c). Immunohistochemically, p57kip2 nuclear stain was not expressed in the cytotrophoblast and stromal cells, but was prominent in the extravillous (intermediate) trophoblasts (d). (Reprinted from International Journal of Surgical Pathology [11] with permission)
Outcome
Due to the presence of ectopic pregnancy in the fallopian tube, the patient underwent laparoscopic salpingectomy. Histopathological examination revealed a molar tubal pregnancy. Chest X ray was reported to be normal. The serum hCG level a week after surgery was 5000 mIU/mL, and a week later was 2100 mIU/mL. The levels continued dropping and 4 weeks after surgery, it was undetectable.
Clinical Pearls/Pitfalls
Ectopic molar pregnancy is rare.
Invasive mole and choriocarcinoma are rare complications.
Clinical diagnosis is difficult.
Approach and follow-up with tertiary center is important since inadequate treatment of molar pregnancy can lead to choriocarcinoma.
Surgical removal of the affected tube is mandatory.
Histopathological examination is needed to rule out the presence of malignancy.
References
1.
Gillespie AM, Lidbury EA, Tidy JA, Hancock BW. The clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation. Int J Gynecol Cancer. 2004;14(2):366–9.CrossRefPubMed
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