The case of the phantom trophoblastic tumor
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This report provides an insight into a very unusual problem in the first trimester of pregnancy,and describes the unfolding of a series of potential blunders. We all know that most problems in gynecologic oncology become terribly magnified when the patient is pregnant.

The patient had a routine ultrasound in the first trimester of pregnancy, and a large, extremely vascular mass occupying most of the lower anterior abdominal wall, was found. Because she had received methotrexate two years earlier for a persistent elevation of the hCG titer following surgery for an ectopic pregnancy, she was referred to the gynecologic-oncology service with the working diagnosis of metastatic gestational trophoblastic disease (GTD).

An MRI revealed a vascular mass in the subcutaneous tissue invading the rectus sheath and muscle, but not attached to the uterus. The report stated, in no uncertain terms, that the mass was strongly indicative of a metastasis from GTD. However, the hCG level was consistent with the estimated gestational age, and a mass such as this would represent an extremely unusual way for this disease to present. She had been told that she would need the have the pregnancy terminated, followed by chemotherapy to reduce the size of the mass prior to its removal.

The management of this patient presented several medical and ethical problems. If this mass was the result of GTD, then the pregnancy, which was greatly desired, would need to be terminated as soon as possible, unless, of course, it could be removed while the she was pregnant. She was referred to a general surgeon who refused to remove the mass until after the pregnancy had been terminated, for fear of causing massive hemorrhage.

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