A case report of Chorioadenoma Destruens or Metastatic Mole

Presented by Dr.Narayan M.Patel M.D,D.G.O.,F.I.C.S Prof.Emeritus, ob/gyn. muni. medical collage, Postal address:- Mahalaxmi institute of medical teaching 3, shantiniketan park, Nr. S. P. Colony Ahmedabad Gujarat state (INDIA) Phone:- (079)

This young Pt. of 23 years came as an emergency case with pain in abdomen and bleeding off and on per vagina. She gives H/O abortion and follows by curettage before 15 days. On admission she was in a state of shock with signs of internal hemorrhage. Diagnosis of ruptured ectopic pregnancy was thought and laparotomy under general anesthesia was done.

On opening abdomen, it was full blood. This was aspirated. On clearing the field of vision, we notice bleeding from a growth that was at the fundus of uterus. The appearance was like that of a malignant growth. Her age was only 23 years, with no child. It was a difficult to take decision to do hysterectomy or not. As a life shaving procedure, we could convince her husband for hysterectomy. We did hysterectomy with heavy heart. Pt. was given blood transfusions. Post operative period was uneventful. Biopsy report came after 7 days as chirion epithilioma.

This slide shows uterus that has been removed along with both ovaries and tubes. The angry looking growth is seen arising from left side of fundus of uterus.

This slide shows same specimen bisected. The fundal growth is seen. The question is whether it was possible to avoid hysterectomy in such a case. Methotraxate as a Chemotherapy agent for vesicular mole was available in tablet form only. This happened somewhere around when I was new in practice, not bold as today.

This patient was given Mithotraxate tablets. She used to come to me often, at 2 to 3 year intervals, for a period of 15 years. Every time she came, she was unhappy for one thing, that I removed her uterus, and she was keen for a child. This was my first and last case seen in 40 years of my practice. There are now reports in literature, such case can be treated conservatively by modern chemotherapy and can even bear a child. Second point to note is how I mistook this case as case of ruptured ectopic pregnancy with massive intra peritoneal hemorrhage.

Chorioadenoma destruens may follow a vesicular mole or an abortion. It has a tendency to erode myometrium, leading to all signs of internal hemorrhage, as in this case. It usually do not metastasize and prognosis is much better than chorion epithilioma. In our case, Pt. lived more than 15 years after the disease. This means biopsy report of chorion epithilioma was wrong. Second point to note is how I mistook this case as case of ruptured ectopic pregnancy with massive intra peritoneal hemorrhage. This case is reported for its rarity.