Molar cornual ectopic pregnancy

A 40-year-old woman, para 3 with last delivery 7 years back attended the Out Patient Department with complaints of irregular and excessive vaginal bleeding and pain in the lower abdomen for 3 months. This was not preceded by any history of amenorrhea. General condition was fair, pallor /1, pulse 84/min, and blood pressure 122/84 mmHg. Abdomen was soft on palpation. On pelvic examination, uterus was asymmetrically enlarged toward the left side corresponding to 12 weeks size. Sonography revealed a hyperechoic mass in the posterolateral wall of uterus with anechoic channels showing flow on color Doppler. The appendages were normal. A dilatation and curettage showed endometrium in proliferative phase. The patient was started on cyclical progesterone for 3 months but her symptoms did not regress. With a provisional diagnosis of fibroid uterus, a hysterectomy was planned. At laparotomy, uterus was asymmetrically enlarged more toward the left cornua. The enlarged part appeared to be soft cystic in consistency with increased vascularity. Both adnexae were normal. A total abdominal hysterectomy was carried out. On the cut section of the specimen, uterine cavity was found to be normal but the left cornual protuberance extruded grape-like vesicles (Figure 1). There was no placenta or fetus. Serum b-HCG in the immediate postoperative period was found to be 2905 mIU/ml. Histopathology revealed a hypertrophied myometrium lined by secretary endometrium and a mass of hydatidiform mole at one cornu. Postoperative period was uneventful. Serum bHCG was performed weekly, which reached normal level within 3 weeks.