EP29.16: Dilemma diagnosis between intramural ectopic pregnancy and invasive gestational trophoblastic disease: a challenging case at Tu Du Hospital in Vietnam

Differentiation between intramural ectopic pregnancy (IEP) and molar ectopic pregnancy is difficult due to its both rarity. However, identified diagnosis plays an important role in prognosis in women of reproductive-age. Herein, we reported a challenging case at Tu Du Hospital in COVID-19 pandemic and review the literature. Case report: A 45-year-old woman was initially presented with abdominal pain and abnormal ultrasonographic findings. Therefore, a preliminary diagnosis of ectopic pregnancy was made, and a laparoscopy was performed. However, no abnormal mass was found in the abdominal cavity during the surgical intervention. Consequently, the patient was suspected for an invasive trophoblastic disease (ITD). According to hospital counselling, and following her negative Covid-19 test, she underwent laparotomy with hysterectomy. Histopathological examination showed an adenomyosis and ITD. Postoperatively, the patient's serum β-hCG level was decreased gradually to the baseline value. A diagnosis of an IEP was made based on serial transvaginal colour Doppler ultrasonography (TV-CDU) and serum β-hCG levels. However, we did not exclude a dilemma diagnosis of an ITD due to the tortuous vascular spectrum image surrounding the intramural heterogeneous mass. IEP can lead to uterine rupture, whereas, ITD is related to malignancy risk. IEP maybe also degenerated to intramyometrial trophoblastic disease. An early management results in preventing complications. An appropriate selection of treatment is depended on clinical evaluation and should be individualised following the patient's fertility desire. In conclusion, a differential diagnosis between an IEP and an ITD is always necessary. TV-CDU and serum β-hCG level are required in a strict monitoring.