Ruptured Large Ectopic Hydatidiform Mole: An Uncommon Presentation of Gestational Trophoblastic Disease Detected by Ultrasound

Gestational trophoblastic disease (GTD) encompasses a range of conditions, including hydatidiform mole, invasive mole, epithelioid trophoblastic tumor, placental site trophoblastic tumor, and choriocarcinoma. Among these, ectopic molar gestation (EMG) is exceedingly rare but possesses a malignant potential comparable to that of intrauterine molar pregnancy. In this report, we present a unique case of EMG diagnosed through ultrasonography (USG), complemented by a brief literature review. A 36-year-old multipara presented at 8 weeks of gestation with severe abdominal pain and spotting. Notably, she had experienced a spontaneous abortion four months prior to this presentation. A transabdominal USG was performed, revealing a large right adnexal hydatidiform mole accompanied by moderate hemoperitoneum. The right ovary was indistinguishable from the surrounding structures, complicating the clinical picture. Consequently, the patient underwent an emergency laparotomy, which included hysterectomy and right adnexal clearance. Histopathological examination subsequently confirmed the diagnosis of complete ectopic hydatidiform mole. This case underscores the critical role of USG as the modality of choice for the initial assessment of suspected GTD, providing reliable evaluation for residual or recurrent disease. Furthermore, it emphasizes the importance of considering EMG in the differential diagnosis of suspected ectopic pregnancy. This report highlights the potential for accurate diagnosis using USG, which can significantly impact clinical management and patient outcomes in cases of GTD.