A Case of Persistent Intrauterine Molar Pregnancy with Final Diagnosis of Heterotopic Molar Pregnancy: A Very Rare Entity

Abstract

Introduction: Gestational trophoblastic disease (GTD) includes hydatiform mole, choriocarcinoma, placental site trophoblastic tumor, and epithelial trophoblastic tumor. Also, molar pregnancy can happen as an ectopic pregnancy. The coincidence of these complicated pregnancies seems to occur extremely rarely. Case presentation: Here, we presented a 26-year-old woman, nulli gravida with the first presentation of intrauterine complete molar pregnancy; she underwent suction curettage but was prompted to Gestational Trophoblastic Neoplasm (GTN) and she received chemotherapy. During chemotherapy, she had severe abdominal pain and underwent laparotomy, and found an ectopic molar pregnancy in the fallopian tube. Salpingectomy was done and followed up with serum human chorionic gonadotropin (hCG) level and again due to improper decrease of hCG levels, she was diagnosed as a heterotopic post-molar GTN and received methotrexate (MTX) in multiple doses, but she did not respond to MTX, so we started actionomycine-D (Act-D) for her. She was cured after receiving 5 courses of Act-D and now she is on her monthly follow-up with an hCG level. Conclusions: It is important to notice the likelihood of ectopic molar pregnancy or a heterotopic molar pregnancy in the case of managing molar pregnancy, especially when we encounter a case’s poor response to medical or surgical therapy.