Primary Gestational Trophoblastic Disease of the Fallopian Tube: A Case Series Analysis and Literature Review.

OBJECTIVE

To review the clinicopathological characteristics, diagnosis, and treatment of tubal gestational trophoblastic disease (GTD) misdiagnosed as tubal pregnancy.

STUDY

DESIGN

From January 1, 2004, to December 31, 2013, a total of 619 patients with GTD were recorded at the Obstetrics and Gynecology Hospital of Fudan University. Among them, 4 cases of tubal GTD were initially misdiagnosed as tubal pregnancies. We retrospectively analyzed the clinicopathologic characteristics, diagnosis, treatment, and prognosis of those 4 patients.

RESULTS

All 4 patients showed symptoms similar to those of tubal pregnancy. The serum human chorionic gonadotropin (β-hCG) level at presentation was elevated >50,000 mIU/mL. All cases were treated by laparoscopic surgery. Misdiagnosis of the 3 cases of complete hydatidiform mole (CHM) and 1 choriocarcinoma were identified by postoperational histopathology. At 7 days postoperation the β-hCG level decreased to 304–6,115 mIU/mL. One case of tubal CHM received a second operation, and 3 cases received chemotherapy due to the unsatisfactory decrease in β-hCG level. The patient with choriocarcinoma received routine adjuvant chemotherapy. All of the patients achieved complete remission, and none relapsed for a median of 20 months’ follow-up.

CONCLUSION

Tubal GTD is rare and is often misdiagnosed for tubal pregnancy. Salpingectomy, intraoperative frozen section, and close follow-up were recommended, and prophylactic chemotherapy was unnecessary.