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A 40 year old woman 12 weeks postpartum presents with irregular vaginal bleeding. Physical examination shows an enlarged uterus. A beta-hCG level is elevated. Imaging shows bilateral ovarian cysts as well as hypervascular heterogeneous mass in the uterus with areas of necrosis and hemorrhage.
Challenge: This is a tough one, what's your impression?Image shown under fair use.
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3 comments:
PCOS -> elevated estrogen/androgens -> feeding some sort of tumor
Choriocarcinoma. The USG findings sound suspiciously like a tumour....elevated hcg levels after pregnancy also point to choriocarcinoma.
yes it is a tumor - chorioCA is the right diagnosis.
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Advanced Maternal Age
Gestational trophoblastic disease refers to a group of lesions arising from the trophoblast epithelium of the placenta and includes the hydatidiform mole (noninvasive local tumors), gestational trophoblastic neoplasia, choriocarcinoma, and placental site trophoblastic tumors. This is a choriocarcinoma, a highly malignant germ cell tumor that can be associated with normal pregnancy.
Source: UpToDate.
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