CASE REPORT Case Report: Acute abdomen presentation revealing a metastatic invasive mole with uterine rupture [version 1; peer review: awaiting peer review] Fatma Dhieb 1 , Miriam Boumediene 1 , Armi Saoussem 2 , Garci Mariem 2 , Mathlouthi Nabil 2 , Linda Bel Haj Kacem 3 , Meriem Ksentini 3 , Miriam Jrad 1 1 Department of Radiology, Charles Nicolle University Hospital, Bab Souika, 1006, Tunisia 2 Department of Gynecology, Charles Nicolle University Hospital, Bab Souika, 1006, Tunisia 3 Department of Pathology, Charles Nicolle University Hospital, Bab Souika, 1006, Tunisia First published: 04 Nov 2021, 10:1115 https://doi.org/10.12688/f1000research.74051.1 Latest published: 04 Nov 2021, 10:1115 https://doi.org/10.12688/f1000research.74051.1 v1 Abstract Gestational trophoblastic neoplasia refers to the aggressive subset of gestational trophoblastic disease, including invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These tumors may have atypical clinical presentations that can mislead the diagnosis. The reported case is a 48-year-old woman in perimenopause, without any history of vaginal bleedings nor molar pregnancy, who presented to the Emergency Department with acute abdominal pain. Serum beta human chorionic gonadotropin (β-HCG) was highly elevated at 261 675.23 mIU/ml. A complicated invasive mole was suspected, and an abdominal computed tomography was performed, showing a moderate hemoperitoneum associated to complex cystic and solid uterine mass, with a common left iliac adenomegaly and multiple pulmonary nodules. MRI showed a multiloculated cystic uterine mass with zones of hemorrhage recalling an invasive mole with perforation of the posterior uterus wall, associated to a high abundance hemoperitoneum. The diagnosis of a metastatic invasive mole complicated of uterine rupture and hemoperitoneum was retained. A surgical intervention was decided immediately and a subtotal hysterectomy with bilateral annexectomy was done. Pathologic examination of the specimen was positive for an invasive mole. The patient was proposed for chemotherapy. This case study will increase awareness of unusual clinical presentations of gestational trophoblastic neoplasia We believe that our case will contribute to the literature not only because of the rarity of this entity in perimenopausal period, but also due the atypical clinical presentation as acute abdomen without vaginal bleeding nor history of molar pregnancy evacuation Open Peer Review Reviewer Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article. Page 1 of 8 F1000Research 2021, 10:1115 Last updated: 04 NOV 2021