Complete molar pregnancy with transformation to choriocarcinoma of the liver: A case report

OBJECTIVE: Highlight a complete molar pregnancy with possible complications and pertinent clinical information to aid doctors in recognizing the disease quickly to provide treatment to limit adverse outcomes. CONTEXT: Complete molar pregnancy is rare and compromises 1:500–1:2000 pregnancies [1-4]. As technology has improved, the presentation of complete molar pregnancy has changed [1,5-6]. SUMMARY: A 19-year old African American female presented to the emergency room (ER) three times within 14 days for abdominal pain. A pregnancy test was positive and on the third visit quantitative β-human chorionic gonadotropin (HCG) was elevated without signs of an intrauterine pregnancy (IUP). Dilation and curettage (D&C) was done with small perforation of the uterus. Pathology report indicated a complete molar pregnancy. The patient failed to follow-up and returned to ER 22 days later where an abdominal mass was found prompting surgery. Hematomas and abdominal adhesions were removed and again pathology showed a complete molar pregnancy. Follow-up HCG levels failed to decrease appropriately so the patient was referred to oncology where metastatic choriocarcinoma of the liver was diagnosed. Chemotherapy was initiated and HCG monitored. Patient was readmitted for infections and complications, but did eventually have her HCG return to zero. DATA SOURCES: Clinical Key, Purdue Library, and UpToDate were used to search for literature. CONCLUSION: Prompt recognition of a complete mole may lead to a less extensive disease process. Presentation has recently changed so it is important to know signs. Patient compliance likely results in fewer complications and costs.