Acta Medica Iranica 2018. 56(7):478-481.

Persistent Low Levels of Beta-hCG: A Pitfall in Diagnosis of Retained Product of Conception
Leila Pourali, Sedigheh Ayati, Parvaneh Layegh, Atieh Vatanchi, Zahra Rastin, Azadeh Shourvi


Persistent low level of beta-hCG (PLL) is defined as rising hCG level no more than two-fold over a three months period. Almost many types of PLL can lead to the wrong diagnosis. Here, we presented two cases of the retained product of conception (RPOC) with persistent low levels of beta-hCG. Both cases were presented with persistent low levels of beta-hCG and abnormal uterine bleeding since first-trimester pregnancy termination. Ultrasonography revealed a vascular mass with extension from the endometrial cavity to myometrium imitating gestational trophoblastic disease (GTD) or arteriovenous malformation (AVM). The final pathologies of both cases were retained product of conception. Imaging features of RPOC can closely imitate those of an AVM or GTN; so, hysteroscopy is one of the best non-invasive procedures which may be helpful in diagnosis and selection of appropriate treatment especially in young patients who desire to preserve their fertility.



Beta-hCG; Conception; Curettage

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Cole LA, Khanlian SA, Muller CY. Detection of perimenopause or postmenopause human chorionic gonadotropin: an unnecessary source of alarm. Am J Obstet Gynecol 2008;198:275.e1.

Khanlian SA, Cole LA. Management of gestational trophoblastic disease and other cases with low serum levels of human chorionic gonadotropin. J Reprod Med 2006;51:812-8.

Cole LA, Butler SA, Khanlian SA, Giddings A, Muller CY, Seckl MJ, et al. Gestational trophoblastic diseases: 2. Hyperglycosylated hCG as a reliable marker of active neoplasia. Gynecol Oncol 2006;102:151-9.

Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetrics. 24th ed. New York: McGraw-Hill Education, 2014:671.

Trinder J, Brocklehurst P, Porter R, Read M, Vyas S, Smith L. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ 2006;332:1235-40.

Abbasi S, Jamal A, Eslamian L, Marsousi V. Role of clinical and ultrasound findings in the diagnosis of retained products of conception. Ultrasound Obstet Gynecol 2008;32:704-7.

van den Bosch T, Daemen A, Van Schoubroeck D, Pochet N, De Moor B, Timmerman D. Occurrence and outcome of residual trophoblastic tissue: a prospective study. J Ultrasound Med 2008;27:357-61.

Jain K, Fogata M. Retained products of conception mimicking a large endometrial AVM: complete resolution following spontaneous abortion. J Clin Ultrasound 2007;35:42-7.

Takeda A, Koyama K, Imoto S, Mori M, Nakano T, Nakamura H. Conservative management of placenta increta after first trimester abortion by transcatheter arterial chemoembolization: a case report and review of the literature. Arch Gynecol Obstet 2010;281:381-6.

Wang YL, Su TH, Huang WC, Weng SS. Laparoscopic management of placenta increta after late first-trimester dilation and evacuation manifesting as an unusual uterine mass. J Minim Invasive Gynecol 2011;18:250-3.

Rein DT, Schmidt T, Hess AP, Volkmer A, Schöndorf T, Breidenbach M. Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. J Minim Invasive Gynecol 2011;18:774-8.

Hamerlynck TW, Blikkendaal MD, Schoot BC, Hanstede MM, Jansen FW. An alternative approach for removal of placental remnants: hysteroscopic morcellation. J Minim Invasive Gynecol 2013;20:796-802.

Darlow KL, Horne AW, Critchley HO, Walker J, Duncan WC. Management of vascular uterine lesions associated with persistent low-level human chorionic gonadotrophin. J Fam Plann Reprod Health Care 2008;34:118-20.

Cole LA. Phantom hCG and phantom choriocarcinoma. Gynecol Oncol 1998;71:325-9.

González Aguilera B, Syrios P, Gadisseur R, Luyckx F, Cavalier E, Beckers A, et al. Persistent low levels of serum hCG due to heterophilic mouse antibodies: an unrecognized pitfall in the diagnosis of trophoblastic disease. Gynecol Endocrinol 2016;32:439-41.

Kido A, Togashi K, Koyama T, Ito H, Tatsumi K, Fujii S, et al. Retained products of conception masquerading as acquired arteriovenous malformation. J Comput Assist Tomogr 2003;27:88-92.


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