Imperial College Healthcare NHS Trust, London, UK
Imperial College London Department of Surgery and Cancer, London, UK.
BMJ Case Rep. 2024 Oct 1;17(10):e259812. doi: 10.1136/bcr-2024-259812.
A multiparous woman in her 40s presented with a positive pregnancy test, vaginal bleeding, abdominal distention and shortness of breath, 8 weeks after her last menstrual period. A serum human chorionic gonadotrophin (hCG) was reported 900 mIU/ml, and a transvaginal ultrasound (TVUS) diagnosed a pregnancy of unknown location. The patient deteriorated re-presenting 6 days later with features of thyrotoxicosis. TVUS demonstrated a 198×110×165-mm intrauterine mass with features of a complete hydatidiform mole (CHM), and a serum hCG was reported as 440 mIU/ml. Due to the discrepancy between hCG level and suspicion of CHM, the hCG was thought to be falsely low secondary to the 'hook effect'. Following appropriate dilution, the hCG was reported as 4 573 344 mIU/mL. She underwent an uncomplicated surgical evacuation of molar pregnancy and was discharged 3 days postoperatively with resolution of her symptoms and follow-up in a regional gestational trophoblastic disease centre.
一位 40 多岁多产的女性，在上次月经后 8 周时出现阳性妊娠试验、阴道出血、腹胀和呼吸急促。血清人绒毛膜促性腺激素（hCG）为 900 mIU/ml，经阴道超声（TVUS）诊断为不明位置妊娠。患者恶化，6 天后再次出现甲状腺毒症表现。TVUS 显示宫内肿块大小为 198×110×165mm，具有完全性葡萄胎（CHM）的特征，血清 hCG 报告为 440 mIU/ml。由于 hCG 水平与 CHM 的怀疑之间存在差异，hCG 被认为是由于“钩状效应”而假性降低。适当稀释后，hCG 报告为 4573344 mIU/ml。她接受了简单的葡萄胎清除术，术后 3 天出院，症状缓解，并在区域妊娠滋养细胞疾病中心进行随访。
