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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2018; 40(05): 294-299
DOI: 10.1055/s-0038-1653976
Case Report
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects

Neoplasia trofoblástica gestacional após gestação molar ectópica: aspectos clínicos, diagnósticos e terapêuticos
Consuelo Lozoya López
1   Department of Pathology, Universidade Federal Fluminense, Niterói, RJ, Brazil
,
Vania Gloria Silami Lopes
1   Department of Pathology, Universidade Federal Fluminense, Niterói, RJ, Brazil
,
Fabiana Rodrigues Resende
1   Department of Pathology, Universidade Federal Fluminense, Niterói, RJ, Brazil
,
Jessica Lara Steim
1   Department of Pathology, Universidade Federal Fluminense, Niterói, RJ, Brazil
,
Lilian Padrón
1   Department of Pathology, Universidade Federal Fluminense, Niterói, RJ, Brazil
2   Rio de Janeiro Trophoblastic Disease Center, Associação Brasileira de Doença Trofoblástica Gestacional, Rio de Janeiro, RJ, Brazil
,
Sue Yazaki Sun
3   Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Edward Araujo Júnior
3   Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Antonio Braga
1   Department of Pathology, Universidade Federal Fluminense, Niterói, RJ, Brazil
2   Rio de Janeiro Trophoblastic Disease Center, Associação Brasileira de Doença Trofoblástica Gestacional, Rio de Janeiro, RJ, Brazil
4   Department of Gynecology and Obstetrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
› Author Affiliations
Further Information

Publication History

17 January 2018

04 April 2018

Publication Date:
16 May 2018 (online)

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Abstract

This report presents the case of a patient with gestational trophoblastic neoplasia after a partial hydatidiform mole formed in the Fallopian tube. Ectopic molar pregnancy is a rare condition, with an estimated incidence of 1 in every 20,000 to 100,000 pregnancies; less than 300 cases of it have been reported in the Western literature. The present report is important because it presents current diagnostic criteria for this rare condition, which has been incorrectly diagnosed in the past, not only morphologically but also immunohistochemically. It also draws the attention of obstetricians to the occurrence of ectopic molar pregnancy, which tends to progress to Fallopian tube rupture more often than in cases of ectopic non-molar pregnancy. Progression to gestational trophoblastic neoplasia ensures that patients with ectopic molar pregnancy must undergo postmolar monitoring, which must be just as thorough as that of patients with intrauterine hydatidiform moles, even if chemotherapy results in high cure rates.

Resumo

Esse relato apresenta um caso de neoplasia trofoblástica gestacional após mola hidatiforme parcial ocorrida na tuba uterina. Trata-se de uma associação rara, cuja incidência estima-se de 1 em cada 20.000 a 100.000 gestações, havendo menos de 300 casos apresentados na literatura ocidental. O tema é importante porque apresenta critérios diagnósticos atuais para essa ocorrência incomum, que vinha sendo diagnosticada equivocadamente, não apenas sob o ponto de vista morfológico, como também imunohistoquímico. Da mesma forma, alerta o obstetra para a ocorrência da gravidez molar ectópica, que tende a evoluir com rotura tubária mais frequentemente do que os casos de gravidez ectópica não molar. Por fim, a evolução do caso para neoplasia trofoblástica gestacional impõe às pacientes com gravidez ectópica molar a necessidade de seguimento pós-molar tão rigoroso quanto nos casos de mola hidatiforme intrauterina, ainda que o tratamento quimioterápico determine elevadas taxas de cura.

Keywords

ectopic pregnancy - hydatidiform mole - gestational trophoblastic neoplasia - pathology

Palavras-chave

gravidez ectópica - mola hidatiforme - neoplasia trofoblástica gestacional - patologia
 

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