A 34-year-old woman has 3 months of intermittent lower abdominal pain and irregular spotting. Uterus is 8 weeks size with a tender left adnexal mass. Serum beta-hCG is 45 mIU/mL. Laparotomy reveals a dark brown haematosalpinx adherent to bowel. Histopathology of the excised tube is most likely to show which finding?
- A Viable proliferating trophoblast invading the muscularis
- B Xanthogranulomatous inflammation without any trophoblastic tissue
- C Degenerated trophoblast with organised clot and few or no chorionic villi ✓
- D Decidualised stroma containing syncytiotrophoblast giant cells
Correct answer: C. Degenerated trophoblast with organised clot and few or no chorionic villi
Explanation
The long course, low or near-normal beta-hCG and old haematosalpinx indicate a chronic ectopic pregnancy, which persists beyond 6 to 8 weeks because the trophoblast has largely died. Histology characteristically shows degenerating trophoblast, organised haematoma and fibrosis, and chorionic villi are often absent, so diagnosis frequently rests on the operative appearance. Viable invading trophoblast describes an acute ectopic, xanthogranulomatous change is nonspecific inflammation, and decidualised stroma with trophoblast suggests an intrauterine gestation.
Reference: Novak's Gynecology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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