Partial hydatidiform mole with false-negative urine human chorionic gonadatropin test in the emergency department.

Hydatidiform mole (molar pregnancy) is a benign tumor of placental trophoblastic cells, which release human chorionic gonadotropin (hCG). Several case reports have described complete hydatidiform moles with false-negative urine qualitative hCG tests. These negative pregnancy tests have been attributed to the hook effect. We report an unusual presentation of a partial mole and review an alternative explanation for the negative hCG test. As partial moles are usually not associated with a large proliferation of trophoblastic cells, levels of hCG are commonly < 100,000 mIU/mL. The most common presentation of a hydatidiform mole is vaginal bleeding. Hydatidiform mole is associated with a risk of malignant transformation and disseminated disease.
In a pregnant patient, vaginal bleeding and abdominal pain are common presentations. Molar pregnancy is an uncommon cause of abdominal pain and vaginal bleeding that should be considered.
A 47-year-old female presented to the emergency department with abdominal pain and vaginal bleeding. Urine qualitative hCG was negative and serum quantitative hCG was 1,094,950 mIU/mL. Pelvic ultrasonography showed a uterine cavity containing a soft-tissue mass with multiple cystic lesions and the hydatidiform mole was extracted with suction curettage. Tissue pathology confirmed partial hydatidiform mole.
In addition to the hook effect, we present another possible explanation for the false-negative test; namely the inability of some assays to detect hCG-degradation products, which may be higher in clinical samples from patients with hydatidiform mole. This case underscores the importance of knowing the limitations of the commonly used hCG assays.
AuthorsTichaendepi Mundangepfupfu, Muhammad Waseem
JournalThe Journal of emergency medicine (J Emerg Med) Vol. 46 Issue 3 Pg. 348-50 (Mar 2014) ISSN: 0736-4679 [Print] United States
PMID24188605 (Publication Type: Case Reports, Journal Article)
CopyrightCopyright © 2014 Elsevier Inc. All rights reserved.
Chemical References
  • Chorionic Gonadotropin
  • Abdominal Pain (etiology)
  • Chorionic Gonadotropin (blood, urine)
  • Emergency Service, Hospital
  • False Negative Reactions
  • Female
  • Humans
  • Hydatidiform Mole (complications, diagnosis)
  • Middle Aged
  • Pregnancy
  • Uterine Hemorrhage (etiology)
  • Uterine Neoplasms (complications, diagnosis)

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