Invasive Mole Complicated by Uterine Perforation and Hemorrhagic Shock: A Case Report

Uterine perforation is a rare but life-threatening complication of gestational trophoblastic neoplasia (GTN), typically described in chemoresistant disease or after treatment discontinuation.We report an unusual presentation that occurred after normalization of beta-human chorionic gonadotropin (β-hCG).A 45-yearold woman, gravida 3, para 2, developed high-risk post-molar GTN after a complete hydatidiform mole; the disease was classified as International Federation of Gynecology and Obstetrics (FIGO) stage III:8, with eight pulmonary metastases.Six cycles of EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) normalized β-hCG and cleared the pulmonary lesions but left a 46.7-mm residual uterine mass.The patient declined the proposed consolidation cycles and surgical resection.Fifteen days later, she was admitted in decompensated hemorrhagic shock (hemoglobin 5.5 g/dL) caused by perforation of the uterine fundus with a 1.3-L hemoperitoneum; she underwent an emergency hemostatic total hysterectomy with bilateral salpingo-oophorectomy.Histology showed mummified molar villi infiltrating the full thickness of the myometrium up to the ruptured serosa, without viable trophoblastic tissue, confirming the diagnosis of invasive mole.Recovery was uneventful, and β-hCG has remained negative during ongoing follow-up.This case suggests that a complete biochemical response does not exclude the risk of perforation; we hypothesize that chemotherapy may eradicate the trophoblastic tissue while leaving a thinned, weakened uterine wall.In patients with a large or transmural residual uterine mass, surgical options may be discussed on an individualized basis, and in hemodynamically unstable patients who do not wish to conceive, hemostatic hysterectomy remains an appropriate treatment.