Complete Hydatidiform Mole with Theca Lutein Cysts: Classic USG and MR Imaging Spectrum

Abstract

A 26-year-old married G2 P2 woman presented with four months of amenorrhoea, abdominal pain, and vaginal bleeding, along with a history of passing grape-like lesions during vaginal bleeding. On examination, the uterus was approximately 14-16 weeks gestation. Transabdominal pelvic ultrasound revealed that the uterus measured 18.5×13.6×6.4 cm, appeared enlarged, bulky in size, shape, and echo pattern with multiple cystic lesions showing a snowstorm appearance [Table/Fig-1]. No foetal parts were identified within it. Bilateral ovaries appeared enlarged with variable sizes of multiloculated cysts within, known as theca lutein cysts [Table/Fig-2]. Elevated levels of beta-Human Chorionic Gonadotropin (β-HCG) around 105000 mIU/mL were present. Consequently, a Magnetic Resonance Imaging (MRI) of the pelvis was performed to detect any myometrial invasion and to confirm the ultrasound findings. No evidence of myometrial invasion was noted on the MRI. The mass showed high signal intensity relative to the myometrium and demonstrated low intensity on the T1- Sagar Vitthal Gund1, Suresh Vasant Phatak2, Kajal Mitra3, Deepali Mohan Tr imukhe4 Keywords: Amenorrhoea, Beta-human chorionic gonadotrophin, Gestational trophoblastic disease, Magnetic resonance imaging, Ultrasonography [Table/Fig-1]: Transabdominal ultrasound image shows an enlarged uterus containing a complex echogenic intrauterine mass containing several small cystic areas (white arrow). (Snowstorm appearance).weighted image [Table/Fig-3]. It showed high intensity on the T2-weighted image with a large number of internal cysts also visible [Table/Fig-4]. Additionally, bilateral ovarian enlargement with variable sized multiloculated cysts known as theca lutein cysts was observed [Table/Fig-5]. Surgery was performed, confirming the diagnosis of a complete hydatidiform mole.

Keywords

• amenorrhoea
• beta-human chorionic gonadotrophin
• gestational trophoblastic disease
• magnetic resonance imaging
• ultrasonography