A rare concomitant association: partial hydatidiform mole with preeclampsia without severe features, hyperthyroidism, torsion of a theca-lutein cyst and choriocarcinoma with pulmonary metastases

TL;DR

A rare case of a partial hydatidiform mole progressing to choriocarcinoma with multiple complications is reported, emphasizing the need for early detection and multidisciplinary care.

Contribution

This case report highlights a rare and complex progression of gestational trophoblastic disease with multiple concurrent complications.

Findings

A partial hydatidiform mole progressed to metastatic choriocarcinoma with pulmonary involvement.

The patient exhibited preeclampsia, hyperthyroidism, and torsion of a theca-lutein cyst alongside trophoblastic disease.

Low to intermediate-risk chemotherapy with etoposide and cisplatin showed an initial favorable response.

Abstract

Gestational trophoblastic disease (GTD) encompasses a spectrum of premalignant and malignant conditions arising from trophoblastic tissue. This case highlights an unusual and severe progression of a partial hydatidiform mole complicated by preeclampsia, hyperthyroidism, torsion of a theca-lutein cyst, and ultimately metastatic choriocarcinoma. The patient’s course illustrates the importance of early recognition, close monitoring, and multidisciplinary management. This rare and instructive presentation underscores the malignant potential of partial moles. Case: A 36-year-old patient who presented with abdominal pain and vaginal bleeding, associated with hypertension and a beta-human chorionic gonadotropin (β-hCG) of 1561722.6 mIU/mL. Ultrasound revealed a pattern suggestive of a partial mole. Manual vacuum aspiration (MVA) was performed, finding 750 mL of vesicular tissue. Histopathological examination confirmed a partial mole. Days later, the patient developed torsion of a theca lutein cyst, which required exploratory laparotomy. During follow-up, β-hCG levels progressively increased, indicating persistent trophoblastic disease. The patient was referred to an oncology center, where she was diagnosed with choriocarcinoma with pulmonary metastases. She is currently undergoing her first cycle of chemotherapy. The chosen regimen was etoposide and cisplatin, administered over four cycles. This decision was guided by a FIGO risk score assessment, which placed the patient in the low to intermediate-risk category. The initial response was favorable, with no observed complications during the first two cycles.

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