An unexpected invasive hydatidiform mole in a rudimentary uterine horn: A case report

Si,Manfei; Li,Peng; Yuan,Zeng; Ma,Hui; Cui,Baoxia; Kong,Beihua

doi:10.3892/ol.2017.6493

An unexpected invasive hydatidiform mole in a rudimentary uterine horn: A case report

Authors:
- Manfei Si
- Peng Li
- Zeng Yuan
- Hui Ma
- Baoxia Cui
- Beihua Kong
View Affiliations

Affiliations: Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China, Department of Emergency, Affiliated Hospital of Shandong Academy of Medical Science, Jinan, Shandong 250031, P.R. China
Published online on: June 30, 2017 https://doi.org/10.3892/ol.2017.6493
Pages: 2808-2812
Copyright: © Si et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Rudimentary horns of the uterus develop as a result of a partial non‑development of one Müllerian duct, a type of congenital uterine anomaly. Pregnancy in a rudimentary horn is uncommon and the outcome tends to be poor, with the majority of cases resulting in rupture between 10 and 15 gestational weeks, with significant risk of morbidity and mortality. Regardless of the availability of imagiological procedures and the advances being made in this field, the diagnosis of this type of ectopic pregnancy often only occurs during laparotomy or laparoscopy subsequent to abdominal pain and collapse. The present study describes a rare case of a uterine rudimentary horn pregnancy. The case was diagnosed by the high serum β‑HCG level, imageological results and dissection of the final pathological specimen, by combined hysteroscopy and laparoscopy. An ultrasound illustrated a suspicious gestational trophoblastic disease in the rudimentary uterine horn, with a rich blood flow signal at the right side of the uterus. A pelvic magnetic resonance image indicated that there was endometrial thickening and gestational trophoblastic disease in the rudimentary uterine horn. The patient was treated with surgery, including rudimentary horn dissection and diagnostic curettage; the ipsilateral adnexa was conserved as it appeared to be normal. Due to the apparent decline of the serum β‑HCG level and the reluctance for chemotherapy, the patient chose to undergo no further treatment and closed follow‑up. At the time of writing, the patient is in a good condition. Only a small number of reports of a horn pregnancy with invasive hydatidiform mole are described by other studies, thereby increasing the clinical significance of this case.

View Figures

View References

1	Chopra S, Keepanasseril A, Rohilla M, Bagga R, Kalra J and Jain V: Obstetric morbidity and the diagnostic dilemma in pregnancy in rudimentary horn: Retrospective analysis. Arch Gynecol Obstet. 280:907–910. 2009. View Article : Google Scholar : PubMed/NCBI
2	Sevtap HK, Aral AM and Sertac B: An early diagnosis and successful local medical treatment of a rudimentary uterine horn pregnancy: A case report. Arch Gynecol Obstet. 275:297–298. 2007. View Article : Google Scholar : PubMed/NCBI
3	Lankford J.C..Mancuso P..Appel R.: Congenital Reproductive Abnormalities. J Midwifery Womens Health. 2013. View Article : Google Scholar : PubMed/NCBI
4	Gonçalves E, Prata JP, Ferreira S, Abreu R, Mesquita J, Carvalho A and Pinheiro P: An unexpected near term pregnancy in a rudimentary uterine horn. Case Rep Obstet Gynecol. 2013:3078282013.PubMed/NCBI
5	The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril. 49:944–955. 1988. View Article : Google Scholar : PubMed/NCBI
6	Pal SK, Purkait D, Modak G and Dawn CS: Pregnancy in rudimentary horn. J Indian Med Assoc. 81:961983.PubMed/NCBI
7	Pal K, Majumdar S and Mukhopadhyay S: Rupture of rudimentary uterine horn pregnancy at 37 weeks gestation with fetal survival. Arch Gynecol Obstet. 274:325–326. 2006. View Article : Google Scholar : PubMed/NCBI
8	Tsafrir A, Rojansky N, Sela HY, Gomori JM and Nadjari M: Rudimentary horn pregnancy: First-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging. J Ultrasound Med. 24:219–223. 2005. View Article : Google Scholar : PubMed/NCBI
9	Siwatch S, Mehra R, Pandher DK and Huria A: Rudimentary horn pregnancy: A 10-year experience and review of literature. Arch Gynecol Obstet. 287:687–695. 2013. View Article : Google Scholar : PubMed/NCBI
10	Nahum GG: Rudimentary uterine horn pregnancy. The 20th-century worldwide experience of 588 cases. J Reprod Med. 47:151–163. 2002.PubMed/NCBI
11	Cheng C, Tang W, Zhang L, Luo M, Huang M, Wu X and Wan G: Unruptured pregnancy in a noncommunicating rudimentary horn at 37 weeks with a live fetus: A case report. J Biomed Res. 29:83–86. 2015.PubMed/NCBI
12	Ng TY and Wong LC: Diagnosis and management of gestational trophoblastic neoplasia. Best Pract Res Clin Obstet Gynaecol. 17:893–903. 2003. View Article : Google Scholar : PubMed/NCBI
13	Lurain JR: Gestational trophoblastic disease I: Epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease and, management of hydatidiform mole. Am J Obstet Gynecol. 203:531–539. 2010. View Article : Google Scholar : PubMed/NCBI
14	Lurain JR and Brewer JI: Invasive mole. Semin Oncol. 9:174–180. 1982.PubMed/NCBI
15	Ngan HY, Bender H, Benedet JL, Jones H, Montruccoli GC and Pecorelli S: FIGO Committee on Gynecologic Oncology: Gestational trophoblastic neoplasia, FIGO staging and classification. Int J Gynaecol Obstet. 83 Suppl 1:S175–S177. 2003. View Article : Google Scholar
16	Lurain JR: Gestational trophoblastic disease II: Classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol. 204:11–18. 2011. View Article : Google Scholar : PubMed/NCBI
17	Nair K and Al-Khawari H: Invasive mole of the uterus-a rare case diagnosed by ultrasound: A case report. Med Ultrason. 16:175–178. 2014. View Article : Google Scholar : PubMed/NCBI
18	van Esch EM, Lashley EE, Berning B and de Kroon CD: The value of hysteroscopy in the diagnostic approach to a rudimentary horn pregnancy. BMJ Case Rep. 2010(pii): bcr08201032292010.PubMed/NCBI
19	Cutner A, Saridogan E, Hart R, Pandya P and Creighton S: Laparoscopic management of pregnancies occurring in non-communicating accessory uterine horns. Eur J Obstet Gynecol Reprod Biol. 113:106–109. 2004. View Article : Google Scholar : PubMed/NCBI
20	Alazzam M, Tidy J, Hancock BW and Osborne R: First line chemotherapy in low risk gestational trophoblastic neoplasia. Cochrane Database Syst Rev. 21:CD0071022009.
21	Newlands ES, Mulholland PJ, Holden L, Seckl MJ and Rustin GJ: Etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EMA) chemotherapy for patients with high-risk gestational trophoblastic tumors refractory to EMA/cyclophosphamide and vincristine chemotherapy and patients presenting with metastatic placental site trophoblastic tumors. J Clin Oncol. 18:854–859. 2000. View Article : Google Scholar : PubMed/NCBI
22	Garrett LA, Garner EI, Feltmate CM, Goldstein DP and Berkowitz RS: Subsequent pregnancy outcomes in patients with molar pregnancy and persistent gestational trophoblastic neoplasia. J Reprod Med. 53:481–486. 2008.PubMed/NCBI
23	Muram D, McAlister MS, Winer-Muram HT and Smith WC: Asymptomatic rupture of a rudimentary uterine horn. Obstet Gynecol. 69:486–487. 1987.PubMed/NCBI