Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2020; 8(8): 1547-1553
Published online Apr 26, 2020. doi: 10.12998/wjcc.v8.i8.1547
Hydatidiform mole in a scar on the uterus: A case report
Hao-Ru Jiang, Wen-Wei Shi, Xiao Liang, Hui Zhang, Yan Tan
Hao-Ru Jiang, Wen-Wei Shi, Xiao Liang, College of Medical Imaging, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Hui Zhang, Yan Tan, Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Author contributions: Shi WW collected the data; Jiang HR reviewed the literature and contributed to drafting the manuscript; Liang X performed the histopathological and immunohistochemical analyses; Zhang H and Tan Y revised the manuscript.
Supported by National Natural Science Foundation of China (General Program), No. 81971593, No. 81771824, and No. 81701681; Precision Medicine Key Innovation Team Project, No. YT1601; Social Development Projects of Key R&D Program in Shanxi Province, No. 201703D321016; and Youth Innovation Fund, No. YC1426.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yan Tan, MD, Professor, Department of Radiology, First Clinical Medical College, Shanxi Medical University, 85 Jiefang South Road, Taiyuan 030001, Shanxi Province, China. tanyan123456@sina.com
Received: January 24, 2020
Peer-review started: January 24, 2020
First decision: February 26, 2020
Revised: April 3, 2020
Accepted: April 8, 2020
Article in press: April 8, 2020
Published online: April 26, 2020
Abstract
BACKGROUND

Cesarean scar molar pregnancy is extremely rare, but the incidence has been rising due to the continuous increase in the rate of cesarean section. The presence of a hydatidiform mole in the scar left on the uterus by the procedure may lead to severe complications. We performed a literature review and found only seven reported cases of cesarean scar molar pregnancy. Accurate diagnosis and appropriate treatment are extremely important for the patients’ prognosis.

CASE SUMMARY

A 35-year-old woman, gravida 4, para 1, complained of vaginal bleeding lasting more than 1 mo and amenorrhea lasting more than 2 mo. The patient’s serum human chorionic gonadotropin was 4287800 IU/L. Ultrasound showed a 11.5 cm × 7.5 cm mass at the anterior lower wall of the uterus. The patient underwent suction evacuation, and partial grape-like tissue mixed with blood clots was removed. Uterine arterial embolization was performed to control intraoperative and postoperative bleeding. Histological examination confirmed the presence of a hydatidiform mole in uterine scar. After surgery, there was still a mass with heterogeneous intensity near the isthmus of the uterus on magnetic resonance imaging. The patient then underwent chemotherapy. During the 6-mo follow-up period, the mass disappeared and the serum human chorionic gonadotropin level gradually decreased to normal level.

CONCLUSION

We report a case of cesarean scar molar pregnancy successfully cured by comprehensive treatment. We found that cesarean scar molar pregnancy was subject to intraoperative bleeding, and uterine arterial embolization before surgery may be helpful.

Keywords: Hydatidiform mole, Cesarean scar pregnancy, Comprehensive treatment, Case report, Magnetic resonance imaging, Literature review

Core tip: We here report a case of cesarean scar molar pregnancy cured by comprehensive treatment including suction evacuation, uterine arterial embolization, and chemotherapy. We also performed a literature review and found that most cases of cesarean scar molar pregnancy were associated with intraoperative bleeding. Uterine arterial embolization might help prevent massive bleeding if used before surgery.