Ectopic Molar Pregnancy: A Rare Case Report with Review of Literature

Abstract

Background: Ectopic molar pregnancy is a rare condition diagnosed post-salpingectomy once the specimen undergoes histopathological examination. Tubal involvement is uncommon in gestational trophoblastic disease and is rarely suspected as it resembles routine ectopic pregnancy. Presentation emphasises the advantages of application to patient care in an attempt to stress the usefulness of histopathological examination in every ectopic pregnancy specimen, as molar complications cannot be absolutely avoided. Aim:  This case is presented to highlight that routine pathological analysis for all biopsied body tissue is compulsory, as undiagnosed molar ectopic pregnancy can result in chronic trophoblastic disease or even distant metastasis. Presentation of the case: Presenting a unique case, 36 years old woman, G6P4A1 at 8+ weeks with right ectopic mass measuring 21x20 mm with moderate hemoperitoneum and serum β-hCG 13,853.85 IU/L. Laparoscopic salpingectomy was done, and histopathology of the specimen revealed features of complete molar transformation. Discussion: The case was a surprise for the surgical team as no preoperative suspicion of complete mole was anticipated. Gestational Trophoblastic Disease results from abnormal proliferation of trophoblastic tissue and incorporates a wide range of diseases. Tubal ectopic hydatidiform moles are quite rare lesions, and very few cases have been reported in the literature. DNA flow cytometry for ploidy analysis and p57 nuclear staining are beneficial for distinguishing between partial and complete moles. The most effective method of treating ectopic pregnancy worldwide is laparoscopic salpingectomy. Conclusion: Prognosis of tubal choriocarcinoma is better than uterine as salpingectomy removes the entire pathology instantly without even the slightest suspicion of molar degeneration of the ectopic mass. There is immense need for histopathology of all ectopic pregnancies for definitive confirmation of hydatidiform mole to avoid persistent trophoblastic tumor complications. Early diagnosis, multidisciplinary management and follow-up improve the prognosis in these rare medical entities.