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 (beta-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 beta-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 beta-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.