Medical history 38 year-old female patient refers 7 weeks of amenorrhea, abdominal pain and vaginal bleeding. Denies comorbidities or chronic-use medications. Physical examination shows normotensive patient with heart rate of 98bpm. Abdominal deep palpation reveals pain in the hypogastric region, without signs of peritonitis. Palpable uterus 10cm above the pubic symphysis, closed cervix without bleedings and normal ovaries. Transvaginal ultrasound was requested (image 1), as well as quantitative serum hCG (756.700).Image 1: Transvaginal ultrasound, sagittal plane, showing the uterine cavity.Question:After analyzing the clinical data and the image, which one is the most likely diagnosis? Ectopic pregnancy Threatened abortion Incomplete abortion Hydatidiform mole Test question (Medical Residence 2016 - UNIFESP) Primigravida was submitted to manual intrauterine evacuation in 05/07/2015 and the material's histology was compatible with complete hydatidiform mole. Later then had an elevation on serum hCG and pelvic ultrasound in 05/29/2015 showed expansive heterogeneous lesion in the uterine cavity, with no visible cleavage plane with the myometrium. Question:Which one is the most likely diagnosis? Hydatidiform mole in regression Molar fragments post-evacuation Relapsing hydatidiform mole Gestational trophoblastic neoplasia Primary germinal neoplasia Time is Up! Time's up
