Intramural pregnancy: a report of 2 cases.

BACKGROUND: Intramural pregnancy is a rare type of ectopic pregnancy and may be easily misdiagnosed as cornual pregnancy or trophoblastic tumor. Hysterectomy is performed due to extensive bleeding and uterine rupture in most cases. The incidence is <1% of ectopic pregnancy. Eighteen cases were reported in the People's Republic of China and 33 in the rest of the world since 1957. For a young woman who wishes to maintain her fertility, it is important to make an early diagnosis and to undertake conservative treatment.

CASES: A 29-year-old woman, gravida 3, para 1, was admitted because of missed periods for >70 days, 1 week of mild vaginal bleeding and lower abdominal pain. Her serum beta-human chorionic gonadotropin (beta-hCG) level was 765 U/L. Transvaginal sonography (TVS) revealed an ill-defined mass measuring 3.0 x 3.5 x 2.0 cm within the fundal myometrium adjacent to the covering. At laparotomy, a mass 3 cm in diameter bulged from the left fundal covering and was resected to the surface of myometrium. The patient preserved her fertility through successful repair of the uterus. A 39-year-old woman, gravida 4, para 1, was admitted because of irregular vaginal bleeding for 2 months after intrauterine device insertion. Her serum beta-hCG level was 228 U/L. TVS revealed amorphous echoes in the uterine cavity. We made an initial, presumptive diagnosis of incomplete abortion. Curettage was performed, but no fetal elements were found. The serum beta-hCG level was 360 U/L after 1 week. Computed tomography revealed a trophoblastic tumor with deep invasion of the myometrium. A subradical abdominal hysterectomy was performed and gave the impression of chorionic carcinoma. Pathologic examination revealed diffuse hemorrhage and early invasion of chorionic villi in the fundal myometrium with focal decidual reaction of the endometrium. The diagnosis of intramural pregnancy was made after the operation.

CONCLUSION: Both cases of intramural pregnancy were treated successfully.