CASE REPORT
Journal of International Surgery and Clinical Medicine (JISCM) 2026.
Volume 6.
Number 1: 9-13
E-ISSN: 2807-7008
Published By :
Surgical Residency Program Universitas Syiah Kuala Persistent hydatidiform mole following incomplete evacuation mimicking post-molar gestational trophoblastic neoplasia successfully managed with repeat suction curettage: a case report Mala Hayati1*.
Cut Meurah Yeni1.
Rizka Aditya1
ABSTRACT
Obstetrics and Gynaecology Department.
Faculty of Medicine.
Universitas Syiah Kuala.
Dr.
Zainoel Abidin General Hospital.
Aceh.
Indonesia *Corresponding author:
Mala Hayati.
Obstetrics and Gynaecology Department.
Faculty of Medicine.
Universitas Syiah Kuala.
Dr.
Zainoel Abidin General Hospital.
Aceh.
Indonesia.
malahayatibenyamin@gmail.
Received: 2026-01-27 Accepted: 2026-04-18 Published: 2026-05-29 Introduction: Hydatidiform mole is the most common form of gestational trophoblastic disease and may progress to post-molar gestational trophoblastic neoplasia (GTN).
Persistent vaginal bleeding and elevated -hCG levels following molar evacuation may indicate persistent trophoblastic disease and create diagnostic challenges, particularly when histopathological evaluation is unavailable.
Case Report: A 27-year-old woman was referred with persistent vaginal bleeding five months after suction curettage for a hydatidiform mole.
Histopathological examination was not performed during the initial evacuation because the anatomical pathology service was unavailable.
Physical examination revealed uterine enlargement and active vaginal bleeding.
Serum -hCG was markedly elevated at 223,759 mIU/mL, and ultrasonography demonstrated an enlarged uterus with a heterogeneous honeycomb appearance suggestive of hydatidiform mole.
The patient underwent repeat suction curettage, and histopathological examination demonstrated persistent hydatidiform mole without evidence of malignancy.
Serial -hCG monitoring showed progressive decline to <2 mIU/mL without chemotherapy.
Discussion: Persistent trophoblastic disease following incomplete evacuation may clinically resemble post-molar GTN because of persistent bleeding, uterine enlargement, and markedly elevated -hCG levels.
Histopathological evaluation and serial -hCG surveillance were essential in distinguishing persistent hydatidiform mole from malignant trophoblastic disease.
Repeat suction curettage facilitated definitive diagnosis and complete remission in this patient.
Conclusion: Persistent trophoblastic disease secondary to incomplete evacuation of a hydatidiform mole may mimic postmolar GTN.
Repeat suction curettage may represent an effective management option in carefully selected low-risk patients with disease confined to the uterus.
Keywords: hydatidiform mole, persistent trophoblastic disease, gestational trophoblastic neoplasia, suction curettage, -hCG.
Cite This Article: Hayati.
Yeni.
Aditya.
Persistent hydatidiform mole following incomplete evacuation mimicking post-molar gestational trophoblastic neoplasia successfully managed with repeat suction curettage: a case report.
Journal of International Surgery and Clinical Medicine 6.
: 9-13.
DOI : 10.
51559/jiscm.
INTRODUCTION
Hydatidiform mole (HM) is the most common form of gestational trophoblastic disease (GTD), a spectrum of pregnancyrelated disorders characterized by abnormal trophoblastic proliferation.
1 The incidence of HM varies geographically, ranging from approximately 1Ae2 per 1,000 pregnancies in Europe and North America to nearly 10 per 1,000 pregnancies in Southeast Asian countries, including Indonesia, where the disease burden remains relatively high.
The condition occurs more frequently at the extremes of reproductive age, and a previous molar pregnancy substantially increases the risk of recurrence.
4 Although most patients achieve complete remission after uterine evacuation, complete hydatidiform mole carries a 15Ae20% risk of progression to post-molar gestational trophoblastic neoplasia (GTN), whereas the risk following partial mole remains considerably lower, approximately 0.
5Ae Histopathological remains the gold standard for diagnosing hydatidiform mole and is essential for accurate classification and risk Sonographic -human gonadotropin (-hCG) levels may raise clinical suspicion.
however, definitive diagnosis requires pathological evaluation of evacuated tissue.
6,7 Post-evacuation surveillance relies on serial quantitative -hCG measurements because persistent, plateauing, or rising -hCG levels may indicate residual trophoblastic disease or progression to post-molar GTN.
8 Early recognition of abnormal -hCG regression allows prompt identification of persistent trophoblastic disease and post-molar GTN, facilitating timely intervention and improving clinical outcomes.
Management Open access:
Published by Surgical https://jiscm.
id/index.
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: 9-13 | DOI: 10.
51559/jiscm.
CASE REPORT
evacuation remains challenging in selected Chemotherapy is the standard treatment for confirmed GTN.
However, repeat suction curettage has emerged as a potential alternative in carefully selected low-risk patients with disease confined to the uterus.
10 Several studies have demonstrated that repeat evacuation can achieve sustained -hCG decline and reduce the need for chemotherapy, although the evidence remains limited, and patient selection criteria continue to be debated.
10,11 Repeat curettage may be particularly valuable when persistent intrauterine disease is suspected, and histopathological confirmation from the initial evacuation is unavailable.
These challenges become more pronounced in resource-limited settings, where access to histopathological services and standardized -hCG surveillance may be restricted, potentially delaying diagnosis and appropriate management.
We report a case of persistent trophoblastic disease following incomplete evacuation of a hydatidiform mole that initially raised suspicion of post-molar GTN.
This case highlights the diagnostic challenges associated with persistent post-molar disease and the potential role of repeat suction curettage in carefully selected low-risk patients.
On admission, obstetric examination demonstrated a uterine fundal height two fingerbreadths above the umbilicus with active vaginal bleeding.
Vaginal examination revealed an open cervical os with fresh bleeding.
The uterus was enlarged and mobile, while no adnexal masses were identified, and the pouch of Douglas was not bulging.
Following a blood transfusion, the hemoglobin level increased to 11.
5 g/dL.
Serum -human chorionic gonadotropin (-hCG) was markedly elevated at 223,759 mIU/mL.
Thyroid function tests showed mildly suppressed thyroid-stimulating hormone (TSH) at 0.
414 AAIU/mL, with normal free T3 and free T4 concentrations.
Pelvic ultrasonography demonstrated 00 x 10.
27 x 8.
65 cm containing a heterogeneous intrauterine mass with a characteristic honeycomb appearance and increased vascularization.
Both ovaries were normal in size, and a right-sided theca lutein cyst was identified (Figure .
Based on the International Federation of Gynecology and Obstetrics (FIGO)/World Health Organization (WHO) prognostic scoring system, the patient had a score of 5, derived from an antecedent molar pregnancy .
, an interval of five months from the index pregnancy .
, a pretreatment -hCG level exceeding 100,000 mIU/mL .
, absence of metastases .
, disease confined to the uterus .
, and no prior chemotherapy .
, indicating lowrisk disease.
Given the persistent vaginal bleeding, markedly elevated -hCG level, and suspicion of persistent trophoblastic disease, repeat suction curettage was Approximately 100 cc of vesicular tissue was evacuated and submitted for histopathological evaluation.
The procedure was completed without complications, and vaginal bleeding resolved immediately after surgery.
Gross examination revealed multiple vesicular tissues consistent with molar products of conception (Figure .
Histopathological demonstrated hydropic chorionic villi with fibromyxoid, edematous, and avascular stroma accompanied by decidual tissue.
CASE DESCRIPTION
A 27-year-old woman was referred from Calang Regional Hospital with persistent vaginal bleeding that had continued for five months following suction curettage for a hydatidiform mole performed at a regional hospital.
Histopathological examination of the evacuated tissue was not performed during the initial procedure because anatomical pathology services were unavailable.
The patient also reported progressive abdominal distension, nausea, and intermittent vomiting.
She denied any sexual intercourse after the procedure.
Vaginal bleeding persisted despite medical treatment and had worsened during the three days before admission.
The patient reported using one to two sanitary pads daily.
Three days before referral, she developed generalized weakness and experienced a syncopal episode.
Evaluation at a secondary hospital revealed a hemoglobin level of 7.
9 g/dL.
Figure 1.
Pelvic ultrasonography showing an enlarged anteflexed uterus with a heterogeneous honeycomb appearance and increased vascularity, suggestive of hydatidiform mole.
Figure 2.
Gross appearance of vesicular tissue evacuated during repeat suction curettage, demonstrating multiple grape-like cystic structures consistent with molar tissue.
Published by Surgical Residency Program Universitas Syiah Kuala | JISCM 2026.
: 9-13 | DOI: 10.
51559/jiscm.
CASE REPORT
Table1.
Serial -hCG measurements during postcurettage follow-up.
Beta-hCG level .
IU/mL) Pre-Curettage October 12, 2023
223,759
Post-Curretage October 16, 2023 40,544.
October 30, 2023 November 7, 2024 November 14, 2024 December 14, 2024 January 14, 2025 February 21, 2025 March 25, 2025 April 20, 2025 May 30, 2025 cytological atypia, invasive trophoblastic proliferation, or malignant features were These findings were consistent with persistent hydatidiform mole rather than confirmed gestational trophoblastic The patient was discharged in stable condition and underwent serial serum -hCG monitoring.
Progressive decline in -hCG levels was observed throughout follow-up, ultimately reaching a normal value of <2 mIU/mL without chemotherapy (Table .
Serial -hCG monitoring demonstrated a continuous decline without plateauing or secondary elevation, eventually reaching complete biochemical remission.
The absence of a rising or plateauing -hCG pattern, together with the histopathological findings and clinical resolution after repeat curettage, supported the final diagnosis of persistent hydatidiform mole secondary to incomplete evacuation rather than postmolar gestational trophoblastic neoplasia.
Written informed consent was obtained from the patient for publication of this case report and accompanying clinical DISCUSSION This case illustrates the diagnostic challenge of persistent trophoblastic disease presenting five months after molar evacuation with persistent vaginal bleeding, marked uterine enlargement, and a markedly elevated serum -hCG concentration.
These findings initially raised suspicion of post-molar (GTN), particularly given the prolonged interval since the initial evacuation and the high -hCG level at presentation.
However, subsequent histopathological evaluation and serial -hCG monitoring demonstrated persistent hydatidiform mole without evidence of malignant Hydatidiform mole is the most common form of gestational trophoblastic disease and carries a variable risk of progression to GTN depending on the histological subtype.
Approximately 15Ae20% of complete hydatidiform moles 5Ae1% of partial hydatidiform moles subsequently develop postmolar GTN, necessitating close postevacuation 12,13 Despite several recognized risk factors, including advanced maternal age, excessive uterine enlargement, large theca lutein cysts, and elevated pre-evacuation -hCG levels, predicting which patients will progress to GTN remains challenging because these clinical parameters have limited predictive 13Ae15 Post-molar GTN is primarily diagnosed through serial -hCG surveillance rather than clinical symptoms alone.
According to the International Federation of Gynecology and Obstetrics (FIGO).
GTN is diagnosed when there is a plateau in -hCG levels across four measurements over three weeks, a rise in -hCG levels across three measurements over two weeks, or histological confirmation of Persistent detectable -hCG beyond six months after evacuation may also support the diagnosis.
Although our patient presented with persistent vaginal bleeding and an initial -hCG level of 223,759 mIU/mL, her subsequent clinical course did not fulfill the FIGO criteria for post-molar GTN.
Histopathological examination following repeat suction curettage revealed hydropic chorionic villi with an edematous, avascular stroma, and no evidence of invasive trophoblastic proliferation or Furthermore, serial -hCG measurements demonstrated a continuous decline without plateauing or secondary elevation until complete normalization was achieved.
These findings strongly favored persistent hydatidiform mole secondary to incomplete evacuation rather than confirmed post-molar GTN.
The absence of histopathological examination during the initial evacuation contributed substantially to the diagnostic uncertainty in this case.
Histopathological evaluation remains the gold standard for confirming hydatidiform mole and distinguishing persistent molar tissue from malignant trophoblastic disease.
many resource-limited settings, access to pathology services remains restricted, which may delay definitive diagnosis and complicate subsequent management This limitation was particularly relevant in our patient because the initial curettage was performed in a hospital without anatomical pathology facilities.
Serial -hCG monitoring remains the cornerstone of post-molar surveillance and provides a sensitive indicator of residual trophoblastic activity.
17 Current study reported that systematic -hCG surveillance enables early detection of GTN and facilitates timely intervention before disease progression occurs.
Delayed recognition of abnormal -hCG trends may permit progression to invasive disease and worsen clinical outcomes.
18 In the present case, the progressive decline of -hCG from 223,759 mIU/mL to undetectable levels without chemotherapy provided strong evidence against active GTN and confirmed successful treatment following repeat evacuation.
The role of repeat suction curettage in patients with suspected post-molar GTN remains controversial.
Chemotherapy is considered the standard treatment for confirmed GTN.
19 However, repeat uterine evacuation has been proposed for selected low-risk patients with disease apparently confined to the uterus.
Surgical management may be particularly useful when residual intrauterine trophoblastic tissue is suspected and fertility preservation is desired.
10,16 Several studies have reported that repeat curettage can induce sustained -hCG remission and reduce the need for chemotherapy in appropriately selected patients, although patient selection criteria remain incompletely defined.
Published by Surgical Residency Program Universitas Syiah Kuala | JISCM 2026.
: 9-13 | DOI: 10.
51559/jiscm.
CASE REPORT
Several clinical factors supported the decision to perform repeat suction curettage in our patient.
The disease appeared confined to the uterus on imaging, and no evidence of metastatic disease was identified, the FIGO prognostic score was 5, indicating lowrisk disease.
Repeat curettage resulted in the successful removal of residual molar tissue, immediate resolution of vaginal bleeding, histopathological confirmation of persistent hydatidiform mole, and eventual normalization of -hCG levels without chemotherapy.
19,20 These findings suggest that repeat suction curettage may represent a reasonable management option in selected patients with suspected persistent intrauterine trophoblastic disease, particularly when the diagnosis remains uncertain.
This report has several limitations.
Histopathological examination from the initial evacuation was unavailable, precluding definitive confirmation of the original molar subtype and preventing direct comparison with the repeat curettage specimen.
As a single case report, the findings cannot be generalized to all patients with persistent trophoblastic Nevertheless, this case highlights an important diagnostic challenge frequently encountered in resourcelimited settings and demonstrates the potential value of repeat suction curettage in carefully selected low-risk patients before initiating chemotherapy.
CONCLUSION
Persistent trophoblastic disease following incomplete evacuation of a hydatidiform mole represents a diagnostic challenge because its clinical presentation may post-molar trophoblastic neoplasia.
Persistent vaginal bleeding, uterine enlargement, and markedly elevated -hCG levels raised suspicion of neoplastic transformation in our patient.
nevertheless, histopathological hydatidiform mole without evidence of Repeat suction curettage successfully removed the retained molar tissue, resulted in progressive normalization of -hCG levels, and eliminated the need for chemotherapy.
This case highlights the importance of histopathological evaluation, postevacuation -hCG surveillance, and careful patient selection when considering repeat uterine evacuation in low-risk disease confined to the uterus.
DISCLOSURES
FUNDING
The authors declare that no funding was received for this study.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.
PATIENT CONSENT
Written informed consent was obtained from the patient for publication of this case report and accompanying clinical AUTHOR CONTRIBUTION MH contributed to patient management, study conceptualization, data acquisition, literature review, manuscript preparation, and manuscript revision.
CMY contributed to study design, data interpretation, literature review, and critical revision of the manuscript.
RA contributed to study supervision, intellectual content, manuscript review, and final approval of the manuscript.
All authors have read and approved the final version of the ACKNOWLEDGMENTS The authors would like to thank Dr.
Zainoel Abidin General Hospital.
Banda Aceh.
Indonesia, for supporting the management and documentation of this REFERENCES