280Lu Metastatic Trophoblastic Disease

  • 28year old female presents with
    • vaginal bleeding for 3 days
    • US 2 days prior
      • no IUP noted.
      • threatened abortion.
      • complex vascular lesion in the endometrium.
      • molar pregnancy or other GTD should be considered.

hCG in female, =100 suggests early pregnancy

  • 2 years earlier
    • lost baby during active labor

CXR Frontal View – Trophoblastic Disease – Cystic Metastasis

CXR Frontal View – Trophoblastic Disease – Cystic Metastasis
28year old female presents with vaginal bleeding for 3 days.  CXR in the frontal view suggests a cystic structure in the right mid to lower lung field.
Ashley Davidoff MD TheCommonVein.net  280Lu 136455c

US Vascular Mass in Intrauterine Cavity

Transverse US Vascular Mass in Intrauterine Cavity
28year old female presents with vaginal bleeding for 3 days.  Gray scale ultrasound (top image) shows a spongiform mass in the cranial aspect of the uterus Color-flow ultrasound shows a highly vascular mass.  Finding are consistent with a hydatiform mole (gestational trophoblastic disease -GTD) but the hCG was only 100. 
Ashley Davidoff MD TheCommonVein.net  280Lu 136457.

US Vascular Mass in Intrauterine Cavity

US Vascular Mass in Intrauterine Cavity
28year old female presents with vaginal bleeding for 3 days.  Gray scale ultrasound (top image) in the sagittal plane, shows a an isoechoic mass  in the cranial aspect of the uterus.  Color-flow ultrasound shows a highly vascular mass.  Finding are consistent with a hydatiform mole (gestational trophoblastic disease -GTD) but the hCG was only 100. 
Ashley Davidoff MD TheCommonVein.net 280Lu 136458.
  • US current
    • no intrauterine pregnancy appreciated
    • highly vascular lesion occupying the left uterine fundus and body
    • measuring up to 4.0 cm.
    • Hcg 98 (down from 100.4 ).
  • Admission US
    • IMPRESSION:
      • No evidence of intrauterine gestation.
      • highly vascular lesion occupying the left uterine fundus and body measuring up to 4.0 cm,
      • suspicious for uterine arteriovenous malformation.2 days later

Next day

Angiography Hypervascular Molar pregnancy
Pre and Post Alcohol Ablation

Angiography Hypervascular Molar pregnancy Pre and Post Alcohol Ablation
28year old female presents with vaginal bleeding for 3 days.  Angiography of the uterine artery shows a hypervascular mass in the uterine v=cavity without an early draining vein (a,b)
Following alcohol ablation of the feeding distal segmental branch of the left uterine artery, (c,d)  reveals that the vascular mass has thrombosed   
Ashley Davidoff MD TheCommonVein.net 280Lu 136460b01L.

 

CT Chest – Cavitating Metastatic Trophoblastic Tumor

CT Chest – Cavitating Metastatic Trophoblastic Tumor
28year old female presents with vaginal bleeding for 3 days s/p ablation of a vascular molar pregnancy.  CT of the chest shows multiple cystic lesions in the lungs bilaterally with slightly thickened walls.  Wedge biopsy confirmed a diagnosis of  placental site trophoblastic tumor
Ashley Davidoff MD TheCommonVein.net 280Lu 136464

 

Final pathology from uterine biopsies and lung biopsy

    • consistent with placental site trophoblastic tumor.

MRI Post Ablation

MRI Post Ablation
28year old female presents with vaginal bleeding for 3 days s/p ablation of a vascular molar pregnancy.  T1 weighted MRI in the axial plane (a) shows a small T1 bright focus in the endometrial cavity, likely representing a small amount of blood.  T2 weighted sequence  shows heterogeneous signal in the endometrial cavity (b).  Following gadolinium administration (c) no vascular mass is appreciated, and absence is confirmed on the subtraction views (d)
Ashley Davidoff MD TheCommonVein.net 280Lu136460b01L.

US  Post Ablation of Placental  Trophoblastic  Disease

US  Post Ablation of Placental  Pelvic ultrasound of a28year old female with known diagnosis of metastatic  placental trophoblastic  disease shows heterogeneous changes with irregular fluid collection in the endometrial cavity (upper image).  Color flow doppler shows no residual hypervascularity (lower image) Gray scale ultrasound shows 
Ashley Davidoff MD TheCommonVein.net 280Lu 136467

CT Post Ablation of Placental  Trophoblastic  Disease

CT Post Ablation of Placental  Trophoblastic  Disease
CT  Post Ablation of Placental  Pelvic ultrasound of a 28year old female with known diagnosis of metastatic  placental trophoblastic  disease shows heterogeneous changes  in the endometrial cavity in axial (a) sagittal (b) and coronal (c) projections. Right sided hydronephrosis is noted
Ashley Davidoff MD TheCommonVein.net 280Lu 136466L