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Obstetrics and gynaecology
Curious phenomenon of ‘hook effect’ in invasive mole
  1. Sakshi Heda1,
  2. Rujuta Fuke2,
  3. Ayush Heda1 and
  4. Preeti Gattani3
  1. 1Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, Uttarakhand, India
  2. 2Government Medical College and Hospital Nagpur, Nagpur, Maharashtra, India
  3. 3Shalinitai Meghe Hospital and Research Centre, Wanadongri, Nagpur, India
  1. Correspondence to Dr Ayush Heda; ayushh2{at}gmail.com

Abstract

Gestational trophoblastic disease is a group of pregnancy-related trophoblastic tumours. Gestational trophoblastic neoplasia refers to its invasive and malignant forms: invasive mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour. Patients exhibit elevated beta human chorionic gonadotropin (β hCG) levels, sometimes exceeding 100 000 mIU/mL. When the serum levels of hCG surpass 500 000 mIU/mL, there is a possibility of encountering a phenomenon called ‘hook effect’ which causes erroneously low or negative value when using the immunometric hCG assays that are presently available in the commercial market. We present a rare case involving a female in mid-30s with an invasive molar pregnancy presenting with bleeding, an abdominal mass, hypertension and hyperthyroidism. Despite a negative urine β hCG test, her serum hCG, after dilution, was recalculated to over 850 000 mIU/mL. MRI confirmed invasive mole. Post-hysterectomy, she received methotrexate chemotherapy. Her β hCG normalised after two cycles, and she remains disease-free for 14 months.

  • Obstetrics, gynaecology and fertility
  • Medical management
  • Cancer - see Oncology

https://doi.org/10.1136/bcr-2024-261848

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: SH, RF and PG. The following authors gave final approval of the manuscript: RF and AH. RF acted as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.