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A 24-year-old primigravida presented to the emergency department with mild vaginal bleeding and lower abdominal pain following 6 weeks' amenorrhoea. The pregnancy test was positive. Her past medical history and systemic examination were unremarkable. Vaginal examination revealed minimal blood and mild left adnexal tenderness. A trans-vaginal ultrasound scan showed an empty uterus, a 2.6 cm left adnexal mass and a small amount free fluid in the pelvis. Laparoscopy revealed a 3×2 cm intact left mid-tubal mass, a 6 cm simple right ovarian cyst and 150 ml blood in the pelvis which was otherwise normal. A left salpingectomy was performed. Figure 1 shows serum β-HCG (human chorionic gonadotropin) titres. She had a successful pregnancy two years later.
The surgical specimen was an intact retort-shaped fallopian tube 50 mm in length, which on sectioning revealed granular grey haemorrhagic material. Microscopically a haemorrhagic necrotic tumour comprising polyhedral shaped mononuclear cells that in many areas were surrounded by syncytiotrophoblasts was seen. Marked nuclear atypia and numerous mitoses, including atypical forms were present. There was invasion of …