Trophoblastic Tumours.
MK presented to the district hospital with severe vaginal bleeding, abdominal swelling, and persistent nausea. She reported that she had noticed the symptoms shortly after her miscarriage but assumed they were related to the miscarriage itself. Over the past month, she experienced increasing fatigue, shortness of breath, and rapid weight loss.
MK is a 28-year-old woman living in a small village in rural Uganda. She is a mother of three and has had a history of multiple miscarriages. Her last pregnancy ended in a miscarriage at 10 weeks, but she did not seek medical care due to the remote location of her village and her belief that traditional remedies would suffice.
MK’s family relies on subsistence farming, and her husband works in a nearby town, making access to healthcare difficult. There is limited awareness of reproductive health in her community, and the family often relies on traditional healers. Financial constraints and a lack of transportation further delayed her seeking medical attention.
On physical examination, she appeared pale and weak, with a distended abdomen. Her uterus was significantly enlarged for the post-miscarriage period, and there was tenderness upon palpation. A pelvic examination revealed excessive vaginal bleeding and a soft, irregular mass.
A pelvic ultrasound was performed, revealing a large, heterogeneous mass within the uterus, suggestive of a molar pregnancy. Her serum beta-hCG levels were markedly elevated, consistent with a diagnosis of gestational trophoblastic disease (GTD).
Presence of an invasive mole, a type of trophoblastic tumour.
Management and Challenges:
Due to the aggressive nature of the tumour and the advanced stage at diagnosis, she required immediate intervention. The district hospital lacked the facilities for comprehensive cancer treatment, so she was referred to a regional oncology centre. However, the distance, coupled with financial limitations, made it challenging for her to access this care. MK was initiated on methotrexate-based chemotherapy at the district hospital while awaiting transfer.
Despite the initiation of chemotherapy, MK’s condition deteriorated due to the advanced disease and complications related to delayed diagnosis and limited resources. She was eventually transferred to the regional oncology centre but faced further delays in receiving definitive treatment. This case underscores the critical need for improved access to reproductive health services and early intervention in sub-Saharan Africa, where trophoblastic tumours can often go undiagnosed until they reach an advanced stage.
(A) Ectopic pregnancy
(B) Invasive mole
(C) Ovarian cyst
(D) Endometrial cancer
(A) Severe vaginal bleeding
(B) Abdominal swelling
(C) Persistent nausea
(D) Seizures
(A) Misdiagnosis by the local clinic
(B) Financial constraints and lack of transportation
(C) Fear of hospitals
(D) Concerns about chemotherapy side effects
(A) Radiotherapy
(B) Methotrexate-based chemotherapy
(C) Surgical removal of the mass
(D) Hormonal therapy
