Publication:

Persistent low-level β-hCG with a hypervascular intrauterine mass after medical abortion mimicking GTN: a diagnostic dilemma

Persistent elevation or plateau of serum beta-human chorionic gonadotropin (β-hCG) following abortion raises suspicion for gestational trophoblastic neoplasia (GTN). However, benign conditions such as retained products of conception (RPOC) and uterine vascular lesions may present with similar biochemical and imaging findings, creating a diagnostic challenge. A 27-year-old multiparous woman presented with persistent amenorrhea following unsupervised medical abortion. Ultrasound revealed heterogeneous intrauterine contents with increased vascularity. Serial β-hCG levels showed a plateauing trend. Due to suspicion of GTN, she received single-dose followed by multi-dose methotrexate therapy. Although β-hCG levels declined, they failed to normalize and imaging demonstrated a persistent hypervascular intrauterine mass. Considering the risk of haemorrhage with uterine instrumentation and the inability to exclude malignancy, total abdominal hysterectomy was performed. Histopathology revealed necrosed retained products of conception. Postoperatively, β-hCG levels became undetectable. Persistent low-level β-hCG with a hypervascular intrauterine lesion may mimic GTN. In selected patients with completed childbearing and diagnostic uncertainty, hysterectomy may serve as both a diagnostic and therapeutic intervention.