Aisha Saleem, Kausar Masoom.
A case of consecutive molar Pregnancies followed by Choriocarcinoma.
J Coll Physicians Surg Pak Jan ;13(3):161-3.

A 38 years old woman presented with a history of amenorrhea for 16 weeks, excessive vomiting for 2 months and vaginal bleeding for 35 days. The patient had a past history of seven molar pregnancies with no live birth. She had been married for 12 years. Two years after her marriage she had her first molar pregnancy. Subsequently, she had 6 repeated molar pregnancies. The duration varied from 12 to 18 weeks and the interval between the consecutive pregnancies was 10 to 20 months. Each time evacuation was done by the local doctor and the patient was transfused blood. Her last molar pregnancy was 18 months ago. She had severe giddiness during the periods and had never practiced any contraceptive method. The husband was not biologically related and there was no familial history of molar pregnancy. Serum bhCG was 1200,000 Units/dl. She was anemic (9 gm/dl), pulse was 98 beats/minute and blood pressure was 100/60 mmHg. She was A positive, while her husband was B positive. The fundal height was about 24 weeks with soft consistency. No fetal parts were palpable. The vulva and vagina were normal. The cervix was soft and admitted tip of finger. All the fornices were full. There was moderate vaginal bleeding. X-ray chest showed multiple small snow storm structures in both lungs. There was a complex mass about 20 x 13.8 cm in the uterus with no fetal parts. Both ovaries had multiple theca leutein cysts of 6 x 8 cm in the right ovary and 8 x 10 cm and 5 x 6 cm in the left ovary. All other abdominal organs were normal. On the basis of clinical picture, her past history of heavy and irregular periods and her desire for permanent sterilization, she was counseled for abdominal hysterectomy, chemotherapy and follow-up. On opening the abdomen the uterus was about 24 weeks size, the surface of the uterus had multiple course vessels. Both the ovaries were cystic and enlarged (orange size). The uterus and ovaries with theca leutein cysts were removed. All other abdominal organs were normal. The histopathology report showed uterine mass (18x14x10 cm) brownish solid and necrotic areas, confirmed the diagnosis of choriocarcinoma and theca leutein cysts in both ovaries. The postoperative period was uneventful.

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