Case 278

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).

After analyzing the clinical data and the image, which one is the most likely diagnosis?

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. 

Which one is the most likely diagnosis?

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