Hydatidiform mole Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(5):294-299
This report presents the case of a patient with gestational trophoblastic neoplasia after a partial hydatidiform mole formed in the Fallopian tube. Ectopic molar pregnancy is a rare condition, with an estimated incidence of 1 in every 20,000 to 100,000 pregnancies; less than 300 cases of it have been reported in the Western literature. The present report is important because it presents current diagnostic criteria for this rare condition, which has been incorrectly diagnosed in the past, not only morphologically but also immunohistochemically. It also draws the attention of obstetricians to the occurrence of ectopic molar pregnancy, which tends to progress to Fallopian tube rupture more often than in cases of ectopic non-molar pregnancy. Progression to gestational trophoblastic neoplasia ensures that patients with ectopic molar pregnancy must undergo postmolar monitoring, which must be just as thorough as that of patients with intrauterine hydatidiform moles, even if chemotherapy results in high cure rates.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(5):294-299
This report presents the case of a patient with gestational trophoblastic neoplasia after a partial hydatidiform mole formed in the Fallopian tube. Ectopic molar pregnancy is a rare condition, with an estimated incidence of 1 in every 20,000 to 100,000 pregnancies; less than 300 cases of it have been reported in the Western literature. The present report is important because it presents current diagnostic criteria for this rare condition, which has been incorrectly diagnosed in the past, not only morphologically but also immunohistochemically. It also draws the attention of obstetricians to the occurrence of ectopic molar pregnancy, which tends to progress to Fallopian tube rupture more often than in cases of ectopic non-molar pregnancy. Progression to gestational trophoblastic neoplasia ensures that patients with ectopic molar pregnancy must undergo postmolar monitoring, which must be just as thorough as that of patients with intrauterine hydatidiform moles, even if chemotherapy results in high cure rates.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):339-343
DOI 10.1590/S0100-720320150005318
We report here a case of gestational trophoblastic neoplasia after spontaneous normalization of human chorionic gonadotropin in a patient with a partial hydatidiform mole. This is the second occurrence of this event to be reported and the first one with proven immunohistochemical evidence. Besides showing the treatment for this pregnancy complication, this case report discusses the possibility of reducing the duration of post-molar follow-up, as well as strategies for early recognition of gestational trophoblastic neoplasia after spontaneous remission of molar pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):339-343
DOI 10.1590/S0100-720320150005318
We report here a case of gestational trophoblastic neoplasia after spontaneous normalization of human chorionic gonadotropin in a patient with a partial hydatidiform mole. This is the second occurrence of this event to be reported and the first one with proven immunohistochemical evidence. Besides showing the treatment for this pregnancy complication, this case report discusses the possibility of reducing the duration of post-molar follow-up, as well as strategies for early recognition of gestational trophoblastic neoplasia after spontaneous remission of molar pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(11):529-529
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(11):529-529
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(1):39-43
DOI 10.1590/S0100-72032013000100008
A dichorionic twin pregnancy with complete hydatidiform mole and coexistent fetus is a rare and challenging situation, whose pathogenesis has not been yet fully understood. We present a case of a 39-year-old woman who underwent intracytoplasmic sperm injection with two embryos transfer. The 12-week gestation ultrasound examination revealed normal fetus and placenta with features of hydatidiform mole, leading to pregnancy termination. Autopsy and histological examinations diagnosed a complete mole coexisting with a normal fetus, and the genetic analysis showed a diploid fetus with biparental genome and molar tissue with paternal diploidy. This case highlighted that complete molar pregnancies may still occur even though pregnancy is achieved after intracytoplasmic sperm injection. A review of the literature was performed by collecting data from the few similar reported cases and by commenting on the pathogenesis of this rare condition.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(1):39-43
DOI 10.1590/S0100-72032013000100008
A dichorionic twin pregnancy with complete hydatidiform mole and coexistent fetus is a rare and challenging situation, whose pathogenesis has not been yet fully understood. We present a case of a 39-year-old woman who underwent intracytoplasmic sperm injection with two embryos transfer. The 12-week gestation ultrasound examination revealed normal fetus and placenta with features of hydatidiform mole, leading to pregnancy termination. Autopsy and histological examinations diagnosed a complete mole coexisting with a normal fetus, and the genetic analysis showed a diploid fetus with biparental genome and molar tissue with paternal diploidy. This case highlighted that complete molar pregnancies may still occur even though pregnancy is achieved after intracytoplasmic sperm injection. A review of the literature was performed by collecting data from the few similar reported cases and by commenting on the pathogenesis of this rare condition.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(6):254-258
DOI 10.1590/S0100-72032012000600003
PURPOSE: To determine the frequency of hydatiform mole in tissues obtained by curettage. METHODS: A cross-sectional, prospective and descriptive conducted on patients who underwent curretage due to a diagnosis of abortion or hydatiform mole whose material was sent for pathological examination. We excluded women who did not accept to participate and refused to sign the free informed consent form. We studied the following variables: pathological findings, age, race, number of pregnancies and previous abortions, gestational age at diagnosis, quantitative serum beta fraction of human chorionic gonadotropin and ultrasound findings. The data were compared to the to histological diagnosis, considered to be the gold standard. Data were stored and analyzed in Microsoft Excel® software and the Epi-Info program, version 6.0 (STATCALC) and the results are presented as frequency (percentage) or mean±standard deviation. The χ2 test was used to determine the association between qualitative variables and the level of significance was set at p<0.005. RESULTS: A total of 515 curettage procedures were performed, 446 of which comprised the sample. The frequency of hydatiform mole was 2.2% (ten cases). The mean age of the patients with a mole was 31±10 years, most patients were white and multiparous and had no history of previous abortions, but there was no significant association between these variables. The pregnancy loss occurred early in patients with and without a mole and the most common complaints in both groups were vaginal bleeding and cramps in the lower abdomen. Quantitative determination of human chorionic gonadotropin was performed in 422 cases (413 with and 9 without a hydatiform mole). The levels of the hormone were higher than 100,000 mIU/mL in 1.9% of the patients without a hydatiform mole and in 44.45% of the patients with the disease (p=0.00004). All patients with this hormonal level had an ultrasound suspicion of hydatiform mole and one of them also had a clinical suspicion. A total of 333 patients underwent ultrasound examination. Of the patients with sonographic findings suggestive of molar pregnancy, there was confirmation in five (41.7%) cases. The other seven (58.3%) were false positives. A significant association was found between ultrasound suspected molar pregnancy and disease confirmation by histopathological analysis (p=0.0001). In 50% of cases of hydatiform mole there was no suspicion of the disease according to clinical signs and symptoms, levels of beta fraction of human chorionic gonadotropin or sonographic findings. CONCLUSIONS: The frequency of hydatidiform mole is low and the disease may not be suspected by clinical examination, ultrasonography or the serum level of the beta fraction of human chorionic gonadotropin, requiring pathological examination of tissue obtained by uterine evacuation for diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(6):254-258
DOI 10.1590/S0100-72032012000600003
PURPOSE: To determine the frequency of hydatiform mole in tissues obtained by curettage. METHODS: A cross-sectional, prospective and descriptive conducted on patients who underwent curretage due to a diagnosis of abortion or hydatiform mole whose material was sent for pathological examination. We excluded women who did not accept to participate and refused to sign the free informed consent form. We studied the following variables: pathological findings, age, race, number of pregnancies and previous abortions, gestational age at diagnosis, quantitative serum beta fraction of human chorionic gonadotropin and ultrasound findings. The data were compared to the to histological diagnosis, considered to be the gold standard. Data were stored and analyzed in Microsoft Excel® software and the Epi-Info program, version 6.0 (STATCALC) and the results are presented as frequency (percentage) or mean±standard deviation. The χ2 test was used to determine the association between qualitative variables and the level of significance was set at p<0.005. RESULTS: A total of 515 curettage procedures were performed, 446 of which comprised the sample. The frequency of hydatiform mole was 2.2% (ten cases). The mean age of the patients with a mole was 31±10 years, most patients were white and multiparous and had no history of previous abortions, but there was no significant association between these variables. The pregnancy loss occurred early in patients with and without a mole and the most common complaints in both groups were vaginal bleeding and cramps in the lower abdomen. Quantitative determination of human chorionic gonadotropin was performed in 422 cases (413 with and 9 without a hydatiform mole). The levels of the hormone were higher than 100,000 mIU/mL in 1.9% of the patients without a hydatiform mole and in 44.45% of the patients with the disease (p=0.00004). All patients with this hormonal level had an ultrasound suspicion of hydatiform mole and one of them also had a clinical suspicion. A total of 333 patients underwent ultrasound examination. Of the patients with sonographic findings suggestive of molar pregnancy, there was confirmation in five (41.7%) cases. The other seven (58.3%) were false positives. A significant association was found between ultrasound suspected molar pregnancy and disease confirmation by histopathological analysis (p=0.0001). In 50% of cases of hydatiform mole there was no suspicion of the disease according to clinical signs and symptoms, levels of beta fraction of human chorionic gonadotropin or sonographic findings. CONCLUSIONS: The frequency of hydatidiform mole is low and the disease may not be suspected by clinical examination, ultrasonography or the serum level of the beta fraction of human chorionic gonadotropin, requiring pathological examination of tissue obtained by uterine evacuation for diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(2):94-101
DOI 10.1590/S0100-72032009000200008
The hydatiform mole is a relatively rare pregnancy complication, but with potential to evolve to forms which need systemic treatment and can be a threat to life. There are two histopathological and clinical entities under the name of hydatiform mole: the partial and the complete mole. The differences between the two forms are important due to risk of evolution to persistent forms, which is higher for the complete moles. The diagnosis, treatment and follow-up of hydatiform mole have been under important changes in the last years. The number of asymptomatic patients has increased, due to the use of ultrasonography at the onset of pregnancy. The use of medication that induces uterine contractions must be avoided, and vacuum aspiration should be used. Soon after emptying the mole, a hormonal contraceptive method should be prescribed. Follow-up should be based on weekly serial dosages of chorionic gonadotropin. It is important that the method employed detects all the forms of chorionic gonadotropins (intact molecule, with hyper glycol, free β subunit, and central fragment β subunit).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(2):94-101
DOI 10.1590/S0100-72032009000200008
The hydatiform mole is a relatively rare pregnancy complication, but with potential to evolve to forms which need systemic treatment and can be a threat to life. There are two histopathological and clinical entities under the name of hydatiform mole: the partial and the complete mole. The differences between the two forms are important due to risk of evolution to persistent forms, which is higher for the complete moles. The diagnosis, treatment and follow-up of hydatiform mole have been under important changes in the last years. The number of asymptomatic patients has increased, due to the use of ultrasonography at the onset of pregnancy. The use of medication that induces uterine contractions must be avoided, and vacuum aspiration should be used. Soon after emptying the mole, a hormonal contraceptive method should be prescribed. Follow-up should be based on weekly serial dosages of chorionic gonadotropin. It is important that the method employed detects all the forms of chorionic gonadotropins (intact molecule, with hyper glycol, free β subunit, and central fragment β subunit).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):506-510
DOI 10.1590/S0100-72032007001000003
PURPOSE: to evaluate the usefulness of the normal human chorionic gonadotropin (hCG) regression curve in the early diagnosis of post-molar trophoblastic neoplasia (GTN). METHODS: a longitudinal study including 105 patients with complete hydatidiform mole (CHM) followed up at the Botucatu Center of Trophoblastic Diseases from 1998 to 2005. Serial serum hCG titers were measured fortnightly in all patients. Individual curves of the 105 patients were built. Comparison between the normal regression curve established at our center with individual hCG curves was used to screen and diagnose (plateau/rise) GTN. The number of weeks postevacuation when hCG levels exceeded the normal limits was compared with the number of weeks when hCG reached plateau/rise. RESULTS: among the 105 patients with CHM, 80 reached spontaneous remission (SR) and 25 developed GTN. Among the 80 SR patients, 7 (8.7%) initially showed hCG concentrations above normal but eventually achieved remission. All the 25 GTN patients showed deviation from the normal hCG curve at 3.84±2.57 weeks and reached plateau or rise at 8.40±2.94 weeks (p<0.001). CONCLUSIONS: the normal regression curve of post-molar hCG is useful in the early diagnosis of GTN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):506-510
DOI 10.1590/S0100-72032007001000003
PURPOSE: to evaluate the usefulness of the normal human chorionic gonadotropin (hCG) regression curve in the early diagnosis of post-molar trophoblastic neoplasia (GTN). METHODS: a longitudinal study including 105 patients with complete hydatidiform mole (CHM) followed up at the Botucatu Center of Trophoblastic Diseases from 1998 to 2005. Serial serum hCG titers were measured fortnightly in all patients. Individual curves of the 105 patients were built. Comparison between the normal regression curve established at our center with individual hCG curves was used to screen and diagnose (plateau/rise) GTN. The number of weeks postevacuation when hCG levels exceeded the normal limits was compared with the number of weeks when hCG reached plateau/rise. RESULTS: among the 105 patients with CHM, 80 reached spontaneous remission (SR) and 25 developed GTN. Among the 80 SR patients, 7 (8.7%) initially showed hCG concentrations above normal but eventually achieved remission. All the 25 GTN patients showed deviation from the normal hCG curve at 3.84±2.57 weeks and reached plateau or rise at 8.40±2.94 weeks (p<0.001). CONCLUSIONS: the normal regression curve of post-molar hCG is useful in the early diagnosis of GTN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(6):331-339
DOI 10.1590/S0100-72032005000600007
PURPOSE: to evaluate the epidemiologic data and signs of trophoblastic hyperplasia in patients with complete hydatidiform mole (CHM) and to estimate the risk associated with the persistence of the disease. METHODS:: we evaluated 214 patients with CHM submitted to uterine evacuation between 1980 and 2001. The patients were included prospectively. All patients were followed until negative bHCG with weekly clinical evaluation and bHCG quantification. We considered persistence when the patient needed another treatment after uterine evacuation. The risk factors for persistence were evaluated through univariate and multivariate analysis, and the odds ratio (OR) was calculated for each one. RESULTS: among the epidemiologic factors, only negative Rh was significant (OR=2.28). All signs of trophoblastic hyperplasia, represented by uterine size larger than expected, sonographic uterine volume, tecaluteinic cysts, and betaHCG higher than 10(5) were associated with risk for the presistence of the disease. The presence of at least one sign of trophoblastic hyperplasia showed sensitivity of 82% and predictive positive value of 35.1% (OR=4.8). The logistic regression identified larger uterine size than expected and bHCG higher than 10(5) as risk factors for persistence of the gestational trophoblastic disease (OR=4.1 and 5.5, respectively). CONCLUSIONS: the signs of trophoblastic hyperplasia showed good sensitivity to predict persistence of the disease; however, the low predictive positive value does not allow using these criteria to change treatment. It is very important to reinforce the importance of serial betaHCG quantification in these high-risk patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(6):331-339
DOI 10.1590/S0100-72032005000600007
PURPOSE: to evaluate the epidemiologic data and signs of trophoblastic hyperplasia in patients with complete hydatidiform mole (CHM) and to estimate the risk associated with the persistence of the disease. METHODS:: we evaluated 214 patients with CHM submitted to uterine evacuation between 1980 and 2001. The patients were included prospectively. All patients were followed until negative bHCG with weekly clinical evaluation and bHCG quantification. We considered persistence when the patient needed another treatment after uterine evacuation. The risk factors for persistence were evaluated through univariate and multivariate analysis, and the odds ratio (OR) was calculated for each one. RESULTS: among the epidemiologic factors, only negative Rh was significant (OR=2.28). All signs of trophoblastic hyperplasia, represented by uterine size larger than expected, sonographic uterine volume, tecaluteinic cysts, and betaHCG higher than 10(5) were associated with risk for the presistence of the disease. The presence of at least one sign of trophoblastic hyperplasia showed sensitivity of 82% and predictive positive value of 35.1% (OR=4.8). The logistic regression identified larger uterine size than expected and bHCG higher than 10(5) as risk factors for persistence of the gestational trophoblastic disease (OR=4.1 and 5.5, respectively). CONCLUSIONS: the signs of trophoblastic hyperplasia showed good sensitivity to predict persistence of the disease; however, the low predictive positive value does not allow using these criteria to change treatment. It is very important to reinforce the importance of serial betaHCG quantification in these high-risk patients.