Successful management of vascular invasive mole by uterine artery embolization and hysterectomy - A case report

Abstract

Gestational Trophoblastic Neoplasia (GTN) is a rare disease originating from pregnancy events that have varied incidences and clinical manifestations based on regional variation. We are reporting a case of a 36-year-old woman with Invasive mole from Central India who presented with abnormal uterine bleeding with severe anemia. She had three full-term vaginal deliveries and 2 spontaneous abortions, the last conception being an abortion around 7 years back. MRI pelvis demonstrated a hypervascular uterine mass suggestive of an Invasive Mole, supported by increased serum β-hCG levels of 31.8 IU/ml. There was no evidence of any metastases on adjunct radiological investigations. After a thorough counselling, the enlarged vascular uterine mass was managed by uterine artery embolization (UAE) followed by simple hysterectomy. Histopathology report confirmed the diagnosis of invasive mole with villi lying in the fibrinous blood clot sheath of the syncytial, and cytotrophoblasts were seen invading the myometrium foci. The patient being in the low risk FIGO scoring, calculated was 5, chemotherapy was not deemed necessary for the patient. Serial post operative β-hCG along with ultrasound pelvis and chest radiogram surveillance showed favourable results with no evidence of metastases even on 6 months follow up. Being a very rare condition, a high index of suspicion with prompt timely management ensures optimum care.