EP21.38: Atypical presentation of invasive mole in a perimenopausal woman

Molar pregnancies usually occurs in women of childbearing age. And, the main symptom is painless vaginal bleeding. But, this patient was 50 years old and admitted to the respiratory medicine department for severe dyspnea. The urine pregnancy test was negative, but serum human chorionic gonadotropin (hCG) was >1,000,000 mIU /mL. A 50-year-old perimenopausal woman was admitted to the respiratory medicine department for one month of severe dyspnea. Blood and imaging findings showed symptoms similar to severe hyperthyroidism. Trans-abdominal ultrasonography showed grape-shaped molar tissues filled the uterus. And there were few remaining uterine muscle layers. Her uterine wall was just before the perforation. Both ovaries were very small atypically. This hCG level is the highest reported so far, but there were no metastatic organs curiously. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. After four months of operation, hCG was normalised without chemotherapy. She has been doing well for the past five years without a recurrence. In conclusions, clinicians should keep in mind that women who are close to menopause should always have a urine pregnancy test and a serum hCG test in mind of the possibility of pregnancy if the diagnosis of menopause is not clear. It is also important to remember that if her blood hCG is too high, her urine hCG may produce false negative. 1.0 U hCG was found to be roughly equivalent to 0.27 mU of thyroid stimulating hormone. Very high hCG stimulates the thyroid gland and show symptoms similar to severe hyperthyroidism. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.