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Chronic tubal ectopic pregnancy with undetectable serum β-hCG mimicking a large ovarian endometrioma: A case report

Year: 2026

Type: article

Abstract: Ectopic pregnancy is usually associated with detectable serum β-human chorionic gonadotropin levels. A rare case of chronic tubal ectopic pregnancy with undetectable beta human chorionic gonadotrophin (β-HCG) that mimicked a large ovarian endometrioma is reported. A 34-year-old multiparous woman presented with prolonged abnormal uterine bleeding and chronic pelvic pain following a 45-day delay in menstruation. Imaging revealed a large complex left adnexal mass measuring 12 × 10 × 7 cm, highly suggestive of ovarian endometrioma. Surgical exploration demonstrated a densely adherent adnexal mass requiring left salpingo-oophorectomy. Histopathological examination confirmed chronic tubal ectopic pregnancy. This case highlights that ectopic pregnancy should remain in the differential diagnosis of adnexal masses even when serum β-hCG is undetectable. • Chronic ectopic pregnancy may present with undetectable serum β-hCG levels. • Large adnexal hematomas can mimic ovarian endometrioma on imaging. • A negative β-hCG test result does not completely exclude ectopic pregnancy. • Histopathology remains the definitive diagnostic method.

Source: Case Reports in Women s Health

DOI: 10.1016/j.crwh.2026.e00814

Authors: Laiqah Al-Dhaheri, Ahlam Al-Kholani

Institutions: 21 September University for Medical and Applied Sciences, Amran University

Language: English

Topic: Ectopic Pregnancy Diagnosis and Management

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,080