31yr, G2 P1 with irregular vaginal bleeding x3 mths and pain lower abdomen x7 days. On examination patient was stable and revealed 6 weeks size uterus with tender firm mass 6x5 cm in right fornix. UPT was positive. TVS showed a well-defined hypoechoic mass 6.4x4.6 cm in tubo-ovarian region with free fluid in POD. Diagnosis was ruptured ectopic pregnancy.
At laparotomy 8x6x6 cm purple colored mass was present replacing a Fallopian tube, with 500 ml hemoperitoneum. Right salphingectomy was done. Left side fallopian tube, bilateral ovaries and rest of uterus were normal. Her β-hCG was 4,37,238mIU/ml. β-hCG was done as mass was suspicious.
It is likely that this is an ectopic pregnancy, but could be an unusual one. Did the "tube"/mass insert into the typical location of the corunua of the uterine body? This could be a rudimentary horn pregnancy. Let us know what the histology shows.
It is likely to be an ectopic pregnancy. The conceptus might have been in the blood collected in POD (as a result of tubal abortion). What are follow up beta-hCG levels?
Pregnancies in rudimentary horn can go unnoticed for long time before they rupture likely to be rudimentary horn pregnancy
What was the hCG level? Of course this could be choriocarcinoma or GTN. The number for the hCG presented in your question does not make sense as there are too many commas present. Is it 4 million? 400,000? 40,000? This detail is important in answering your quiz.
The picture is highly suggestive of ectopic pregnancy, A histological analysis of the specimen should help to confirm. Furthermore, a declining serum BHCG should be a additional confirmatory evidence.
This kind of GTN needs especiall attention , it is resistant to chemotherapy and I had a GTN ectopic pregnancy that eventually hysterectomy was done.