A case report of

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A case report of Chorioadenoma Destruens
or Metastatic Mole
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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-380014 Gujarat
state (INDIA) Phone- [phone] E-mail-naray
anpatel1932_at_yahoo.com
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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.
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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.
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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.
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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 1979-80 when I was
new in practice, not bold as today.
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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.
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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.
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Thank You