Merhaba Misafir

What is your diagnosis?

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A P2L2 woman aged 35 years presented to our outpatient department with amenorrhea of 8 months with episodes of on-and-off heavy bleeding per vaginum. She had a history of laparoscopic right salpingectomy for right tubal ectopic pregnancy 8 months previously, which was confirmed on histopathology (HPE). When she presented to us, she was carrying ultrasonography (USG) of her pelvis, computed tomography (CT) of the abdomen and pelvis, and several human chorionic gonadotropin (beta-hCG) reports of last 8 months. Imaging was absolutely normal and beta-hCG values were showing a waxing and waning course (Figure 1), but never came below a discriminatory zone despite two courses of methotrexate (MTX) in doses of 50 mg/m2 in single dose regimens. A provisional diagnosis of pregnancy of unknown location (PUL) was made at that time because a pregnancy test was positive, serum beta-hCG was 10,304 IU/L, and no intra or extra-uterine gestation could be cited on ultrasound. She had no spells of abdominal pain or fainting attacks. On being referred to our unit, we evaluated her on the lines of gestational trophoblastic neoplasia (GTN) in view of persistently high beta-hCG for the last 8 months (graphical presentation of beta-hCG shown in Figure 1). Routine blood investigations, chest X-ray, USG pelvis, as well as CT chest and brain were found as normal. We did not repeat CT of the abdomen and pelvis. Considering persistently high beta-hCG values without any evidence of pregnancy on imaging, two courses of single agent chemotherapy (MTX-FA) in a multiple dosage regimen (Inj. MTX 1 mg/kg/day on days 1, 3, 5, and 7, and Inj. Folinic acid 15 mg on day 2, 4, 6, and 8) was given intravenously, 2 weeks apart; however, beta-hCG value remained high.

Yayınlandığı Kaynak : Journal of the Turkish-German Gynecological Association
  • Yıl : 2017
  • DOI : 10.4274/jtgga.2017.0023
  • Cilt : 18
  • ISSN : 1309-0399
  • Sayı : 3
  • eISSN : 1309-0380
  • Sayfa Aralığı : 154-157
  • IO Kayıt No : 57134
  • Yayıncı : Turkish-German Gynecological Association