Uterine mass after caesarean section: a report of two cases
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(2020) 20:508
CASE REPORT
Open Access
Uterine mass after caesarean section: a report of two cases Lin-yu Zhou, Xiao-dan Zhu, Jian Jiang and Tian-an Jiang*
Abstract Background: Caesarean scar pregnancy (CSP) is a rare complication of caesarean delivery and a special type of ectopic pregnancy. Gestational trophoblastic neoplasia (GTN) is an uncommon complication of pregnancy. Early diagnosis of the two diseases is crucial because a delay or misdiagnosis can lead to increased maternal morbidity and mortality. Case presentation: We report two cases of uterine isthmus lesions with a previous caesarean section (CS). Two patients were misdiagnosed based on the first ultrasound exam. The first case of trophoblastic tumour was initially diagnosed as CSP, while the second case, which had a scar pregnancy, was misdiagnosed as GTN. The misdiagnoses were due to the particularity of the locations of the lesions in the two patients, complicating the ultrasound-based diagnosis and hindering early clinical diagnosis and treatment. Conclusions: A medical history, β-hCG measurements and transvaginal ultrasound are necessary to diagnose lesions in the lower anterior wall of the uterus early. However, when the location cannot be determined, magnetic resonance imaging (MRI) can be further performed to determine whether the lesion is located at the uterine scar. Combined with the degree of increased β-hCG, differentiate CSP, myometrial GTN or caesarean scar GTN is helpful. Keywords: Gestational trophoblastic neoplasia, Scar pregnancy, Caesarean section, Contrast-enhanced Ultrasound
Background The World Health Organization (WHO) reported that the mean caesarean section (CS) rate of 9 countries in Asia was 27.3% in 2010 and reached 46.2% in China [1]. The prevalence of CS differs between countries. The incidence of caesarean scar pregnancy (CSP) in China is higher than that in other countries. With the change in the one-child policy, more women have chosen to become pregnant again and will therefore face the risk of CSP [2]. CSP is a rare complication of caesarean delivery and a special type of ectopic pregnancy. CSP is refers to a pregnancy in which the embryo has implanted in the hysterotomy scar, is partly or completely located outside the uterine cavity, and is surrounded by myometrial and * Correspondence: [email protected] Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Zhejiang Province 310003 Hangzhou, P.R. China
fibrous scar tissue [3]. The mechanism is speculated to involve the implantation of blastocysts in the tiny dehiscence tracts of the scar after prior caesarean section [4, 5]. Due to the fibrous nature of scar tissue, as the CSP enlarges, these inherently insufficient implant sites are at risk of rupture, placenta accreta spectrum, and haemorrhage. Ultrasound is the main imaging modality for the diagnosis of CSP, although accurate and early diagnosis of CSP may be difficult [6, 7]. In previous studies, approximately 15% of cases were o
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