Metastatic mixed gestational trophoblastic tumour of the uterus: A case report

A 34 year-old Caucasian woman was referred to our Obs/Gyn division, presenting with unexplained metrorrhagia, almost 4 months after normal childbirth. All laboratory tests were unremarkable, except for elevated serum β-HCG (4333 IU/L) and CA-125 levels (366 KU/L). The patient was then referred to our Radiology unit, for a Chest X-ray and abdominal ultrasound evaluation; a dishomogeneously hypoecoic uterine mass (4.4x4.2 cm, Figure 1) was noted. Except for this finding, the initial imaging tests were otherwise unremarakable. The patient was immediately scheduled for a contrast-enhanced Pelvic MRI evaluation, that confirmed the presence of a dishomogenous, irregularly round mass (4.5x4.3x3.6 cm, Figures 2-5), in the endometrial cavity but protruding outwards, eroding the myometrium, the latter barely recognisable at the right lateral aspect of the uterine fundus. The postcontrast acquisitions showed the mass to be highly vascular, almost reaching the outlying sierosa. Figure 1. Ultrasound appearance of the mixed PSTT/Choriocarcinoma GTN. A rounded, heterogeneously ecoic mass is noted within the endometrial cavity