God’s first cancer, an unusual presentation-molar pregnancy implantation in a caesarean scar.

Abstract

Introduction: Gestational trophoblast disease (GTD) forms a spectrum of illnesses that are rare, almost always highly curable, but not always well understood by non‐specialists. The types of trophoblast disease range from the usually benign partial molar pregnancy through complete molar pregnancy and invasive mole to the malignant choriocarcinoma and placental site trophoblast tumours. All of these illnesses share the characteristic that they arise from a pregnancy. While ectopic pregnancy may occur in 11:1000 pregnancies (mortality 1.7 per 10,000 cases caesarean scar ectopic is an extremely rare condition with an incidence of between 1:1800–2216 pregnancies. The coexistence of these two conditions have not been reported in Australia with only a handful described internationally. Methods: I present the case of a 34 year old multiparous lady presented with the unfortunate diagnosis of a molar pregnancy implanted in her caesarean scar. She was initially treated at a metropolitan centre before requiring transfer to a specialist unit. Results: The patient presented with a torrential vaginal bleed after failed initial management of her gestational trophoblastic disease. She required transfer to a gynae‐oncology centre and was administered chemotherapy. She was counselled of the need for, but declined, a hysterectomy. Discussion: I discuss the clinical manifestations, appropriate diagnostic tools and management of this extremely unusual and unexpected clinical case.