History: 33 yo pregnant female with severe nausea and vomiting
Solution: Gestational trophoblastic disease (GTD) is a rare group of disorders/cancers that occur as a result of an aberrant fertilization and it can vary on a spectrum from a benign hydatidiform mole to an invasive choriocarcinoma with malignant and metastatic potential. There are three main types: Hydatidiform mole, which can be complete (no fetal tissue) or partial (some fetal tissue), chorioadenoma/choriocarcinoma which are the cancerous forms, and placental-site GTD, a rare form that arises where the placenta was attached. The large majority of these, even choriocarcinoma are curable with appropriate diagnosis and management. The findings on ultrasound are typical in this case with a vesicular pattern in the endometrial cavity and no identifiable fetus. The ovaries are often enlarged and can have numerous cysts as in this case. The treatment is primarily surgical (D and C or hysterectomy depending on the clinical scenario), but may require chemotherapy if there is evidence of spread outside of the uterus. Women can often have successful pregnancies later once this has been successfully treated.