38 years female underwent suction curettage since one year for confirmed histologically vesicular mole. Bhcg showed plateau titre of 1000 , MTX was given for 6 cycles but after one year still a plateau of Bhcg 20 for nearly 2 months . us showed echogenic mass 1cm in fundoposterior segment of the uterus with low flow. the female is regular menstruating with non contraception. please provide differential diagnoses and management.
It could be the case of persistent Trophoblastic disease already patient has recevied 6 cycles of methotrexate.in view of raised beta HCG still we can give three more cycles of methotrexate.i have similar case in ayoung lady her beta hcg level came down after 10 cycles of methotrexate.first 6 cycles given then waited again patient had raised beta hcg like in your case.we admitted and given four more cycles and she responded. the second remote possibility of invasion of mole or developing early choriocarcinoma the close follow up of beta hcg level with good ultrasound and Doppler effect can give progress of the disease.if progressive then combination of chemotherapy and further treatment will be required.at this stage patient may respond to methotrxate 4 cycles.
Chronic ectopic pregnancy is the diagnosis. First of all, mrg is necessary for the confirmation of location. Treatment for this condition is intrakaviter mtx administration.
Check to ensure that the hcg result is real. Interfering substances can cause a persitently low positive hcg level. Test the urine. If the urine hcg is positive, then the result is real. If the urine is negative, have your lab test the serum hcg using a different analytic method.
- Badges
- Science topic
- Similar topics
- Biological Science
- Immunology
- Antibodies