Invasive mole after heterotopic pregnancy in a postmenopausal woman: A rare case report from a tertiary hospital in northern Tanzania.

introduction and importanceInvasive moles (IMs) are a rare form of gestational trophoblastic disease (GTD) characterized by molar tissue made up of hydropic villi with an overgrowth of trophoblastic cells. These can penetrate the myometrium or uterine vessels in women of reproductive age. Its occurrence in postmenopausal women is exceedingly rare, and even more unusual when arising after a heterotopic pregnancy. Such presentations pose significant diagnostic and therapeutic dilemmas, particularly in resource-limited settings where access to advanced diagnostics and oncology services may be constrained. CASE PRESENTATION: We report a rare case of invasive mole in a 48-year-old woman, 3 years postmenopausal, from Northern Tanzania. She presented to our tertiary hospital with a 3-month history of lower abdominal pain, abdominal distension, and per vaginal bleeding. The patient had a prior history of molar evacuation and left salpingectomy for a heterotopic ectopic pregnancy. Post-evacuation, she did not undergo serial monitoring of serum β-hCG levels. Abdominal ultrasonography revealed a bulky uterus with a heterogeneous, myometrium-infiltrating mass, raising suspicion of uterine choriocarcinoma. In view of the findings and clinical condition, a total abdominal hysterectomy was performed. Histopathological examination confirmed an invasive mole, stage I, with a FIGO prognostic score of 7. Despite counseling, the patient declined adjuvant chemotherapy. CLINICAL DISCUSSION: In this rare case report, we discuss the rarity of invasive mole in a postmenopausal woman after heterotopic pregnancy and underscores the importance of β-hCG surveillance for early detection.

conclusionThis case highlights the diagnostic and therapeutic challenges of invasive mole in a postmenopausal woman after heterotopic pregnancy in a resource-limited setting. The absence of post-evacuation β-hCG surveillance contributed to delayed recognition. Clinicians should maintain a high index of suspicion and emphasize the importance of hCG monitoring for early detection and optimal management of GTN. Also should maintain a high index of suspicion for GTN in women with abnormal bleeding even after menopause.