44-year-old female with elevated hCG, suspicious for molar pregnancy, rule out ectopic pregnancy. The patient's last pregnancy is 10 years ago.

Procedure: Exploratory laparotomy with total abdorminal hysterectomy.

Gross: The specimen consists of a resected uterus with connected uterine cervix. The uterus is deformed by a hemorrhagic ruptured mass lesion at the left cornu, measuring 3.5 x 3.2 x 3 cm. The deformed uterine corpus measures 6.5 cm. from cornu to cornu, 10 cm. from fundus to ectocervix, and 4.5 cm. from anterior to posterior. The serosal surface of the uterine corpus is largely unremarkable, except the left cornu, with hemorrhagic perforated lesion. Bilateral parametrial resection margins are shaggy and hemorrhagic. The ectocervix is lined by tan, smooth squamous epithelium with patchy acute hemorrhage. The ectocervical os is slit in shape and measuring 1 cm. The endometrial cavity measures 4.5 x 4 x 0.2 cm. The patent endocervical canal measures 4 cm. in length with a maximal diameter of 2 cm. The endometrium is pale, tan, soft with a thickness of 0.2 cm. The cut surface of the myometrium is unremarkable and up to 2.2 cm. in thickness. Representative sections are submitted.

Micro: Sections through the hemorrhagic mass at the left cornu show proliferation of mixed cytotrophoblast and syncytiotrophoblast with extensive acute hemorrhage and fibrin deposition. The syncytiotrophoblast exhibits densely eosinophilic cytoplasm and large vesicular multiple nuclei with clumped chromatin. The cytotrophoblast have discrete, mononucleate, oval to polygonal cells with clear to pale cytoplasm, convoluted nuclei, macronucleoli and scattered mitotic figures. The syncytiotrophoblast invades the surrounding myocardium. A few large atypical cells are present in the vascular spaces. Focal tumor necrosis and infarction is noted. Sections through the uninvolved uterine corpus show atrophic endometrium with a few slightly dilated glands. There is no evidence of complex hyperplasia or malignancy. No decidua or pregnancy related tissue is observed in the examined endometrium. Sections through the uterine cervix show Nabothian cysts and mild chronic endocervicitis. There is no evidence of cervical dysplasia or squamous carcinoma. H & E stain.

IHC studies:
hCG Positive, diffuse
Ki-67 Positive (>90% of tumor cells)
PLAP Negative