Presentation
Elevated beta human chorionic gonadotropin hormone (B-hCG) following spontaneous vaginal delivery.
Patient Data
The puerperal, moderately bulky uterus measures 522 ml in volume. A conspicuous round to ovoid-shaped lesion (measuring 2.98 x 2.7 cm) with mid-level echogenicity is noted within the posteromedial myometrium. The lesion is subtly vascularized on Doppler imaging. There is insignificant (3.8 mm in-depth) hypoechoic lochia noted within the uterine lumen. The cervix looks normal.
The ovaries are enlarged (right ovary = 125 cc, left ovary= 138 cc) with multilocular theca luteal cysts ranging from 1.8 to 2.4 cm in diameter. Mild, clear fluid is noted within both iliac fossae.
The upper abdominal organs are normal.
Case Discussion
Ultrasound showed a focal nodule within the posteromedial myometrium with mild peripheral vascularity accompanied by multiloculated bilateral ovarian enlargement. In the postpartum setting with elevated beta human chorionic gonadotropin (B-hCG = 136095.0 mIU/mL), which continued to increase, gestational trophoblastic disease was considered likely. Such sonographic features as illustrated above may favor chorioadenoma destruens, invasive mole, or choriocarcinoma 1.
An MRI scan (not shown) revealed a well-defined nodule in the posterior myometrium without diffusion restriction as well as endometrial thickening, bilateral multiloculated hypointense multicystic ovaries (theca lutein), segment VI T2W hypointense liver lesion likely metastatic, and probable lung metastases. The uterine lesion was interpreted as a hormonally active metastatic gestational trophoblastic disease (GTD). The patient was treated with chemotherapy for choriocarcinoma but subsequently succumbed.
The imaging findings could have a differential diagnosis of a myometrial polyp or solitary fibroid; however, the elevated B-hCG levels and ovarian features favor GTD.
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