scholarly journals Successful Primary Treatment of a Hydatidiform Mole with Methotrexate and EMA/CO

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
M. De Vos ◽  
M. Leunen ◽  
C. Fontaine ◽  
Ph. De Sutter
Keyword(s):  
Surgical Treatment ◽  
Complete Remission ◽  
Treatment Option ◽  
Hydatidiform Mole ◽  
Uterine Fibroids ◽  
Treatment Method ◽  
Primary Treatment ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Hydatidiform Moles

Background. The preferred treatment method of most hydatidiform moles is suction aspiration. In rare circumstances uterine abnormalities may preclude surgical treatment.Case. We report a case of complete molar pregnancy successfully treated with methotrexate followed by EMA/CO. A 38-year-old woman with a complete hydatidiform mole and multiple uterine fibroids underwent a failed attempt at suction aspiration. Following treatment with methotrexate, a nonmetastatic persistent trophoblastic tumour developed. Six cycles of EMA/CO led to complete remission.Conclusion. We propose that primary treatment of molar pregnancies with chemotherapy is a useful treatment option in cases where uterine abnormalities interfere with suction aspiration.

scholarly journals Hydatidiform Moles: Ancillary Techniques to Refine Diagnosis

2018 ◽  
Vol 142 (12) ◽  
pp. 1485-1502 ◽  
Author(s):  
Brigitte M. Ronnett
Keyword(s):  
Interobserver Variability ◽  
Hydatidiform Mole ◽  
Immunohistochemical Analysis ◽  
Gestational Trophoblastic Disease ◽  
Complete Hydatidiform Mole ◽  
Algorithmic Approach ◽  
Genetic Features ◽  
Polymerase Chain ◽  
Dna Genotyping ◽  
Hydatidiform Moles

Context.— Distinction of hydatidiform moles from nonmolar specimens and subclassification of hydatidiform moles as complete hydatidiform mole versus partial hydatidiform mole are important for clinical practice and investigational studies. Risk of persistent gestational trophoblastic disease and clinical management differ for these entities. Diagnosis based on morphology is subject to interobserver variability and remains problematic, even for experienced gynecologic pathologists. Objectives.— To explain how ancillary techniques target the unique genetic features of hydatidiform moles to establish diagnostic truth, highlight the issue of diagnostic reproducibility and importance of diagnostic accuracy, and illustrate use of p57 immunohistochemistry and polymerase chain reaction–based DNA genotyping for diagnosis. Data Sources.— Sources are the author's 10-year experience using ancillary techniques for the evaluation of potentially molar specimens in a large gynecologic pathology practice and the literature. Conclusions.— The unique genetics of complete hydatidiform moles (purely androgenetic), partial hydatidiform moles (diandric triploid), and nonmolar specimens (biparental, with allelic balance) allow for certain techniques, including immunohistochemical analysis of p57 expression (a paternally imprinted, maternally expressed gene) and genotyping, to refine diagnoses of hydatidiform moles. Although p57 immunostaining alone can identify complete hydatidiform moles, which lack p57 expression because of a lack of maternal DNA, this analysis does not distinguish partial hydatidiform moles from nonmolar specimens because both express p57 because of the presence of maternal DNA. Genotyping, which compares villous and decidual DNA patterns to determine the parental source and ratios of polymorphic alleles, distinguishes purely androgenetic complete hydatidiform moles from diandric triploid partial hydatidiform moles, and both of these from biparental nonmolar specimens. An algorithmic approach to diagnosis using these techniques is advocated.

scholarly journals A Case of Invasive Mole

2017 ◽  
Vol 12 (2) ◽  
pp. 86-87
Author(s):  
Shahana Ahmed ◽  
Dipti Rani Shaha
Keyword(s):  
Hydatidiform Mole ◽  
The Body ◽  
Emergency Laparotomy ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Partial Hydatidiform Mole ◽  
Normal Limits ◽  
History Of ◽  
Invasive Mole

Invasive mole is a condition where a molar pregnancy, such as a partial hydatidiform mole or complete hydatidiform mole, invades the wall of the uterus, potentially spreading and metastasizing to other parts of the body. Here is a case who presented with history of evacuation for molar pregnancy. She presented with irregular P/V bleeding on and off and after admission silent perforation with massive haemoperitoneum was detected for which emergency laparotomy was done. She recovered and was followed up till her b-hCG levels were within normal limits. As patient presented to us with haemoperitoneum and on laparotomy, there was invasion into whole of the uterus, it could not be saved and hysterectomy was done.Faridpur Med. Coll. J. Jul 2017;12(2): 86-87

scholarly journals Pemphigoid Gestationis after Spontaneous Expulsion of a Massive Complete Hydatidiform Mole

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Naoki Matsumoto ◽  
Marie Osada ◽  
Kou Kaneko ◽  
Ken Ohara ◽  
Daito Noguchi ◽  
...  
Keyword(s):  
Hydatidiform Mole ◽  
Vital Signs ◽  
Oral Prednisolone ◽  
Skin Lesions ◽  
Complement C3 ◽  
Entire Body ◽  
Complete Hydatidiform Mole ◽  
Pemphigoid Gestationis ◽  
Spontaneous Expulsion ◽  
Hydatidiform Moles

Pemphigoid gestationis (PG) is a rare, perinatal, autoimmune, and blistering dermatosis. Only few cases of PG involving hydatidiform moles have been reported. Complete hydatidiform moles are usually evacuated by dilatation and curettage. We report a patient with a massive complete hydatidiform mole that underwent spontaneous expulsion; she subsequently developed PG. A 19-year-old unmarried nulligravid woman was referred to our hospital following excessive vaginal bleeding after an uncertain amenorrheal period. The patient presented with preshock vital signs, severe anemia, and a positive urine pregnancy test. Imaging examinations revealed a massive intrauterine mass (19 × 15 × 10 cm), suggesting a complete hydatidiform mole. She was hospitalized and treated with blood transfusion. Sixteen hours after hospitalization, the massive molar mass underwent spontaneous expulsion and bleeding ceased. Three days after the expulsion, she developed pruritic skin lesions including papules, erythemas, and bullae, which spread over her entire body. Skin biopsy revealed PG and subepidermal blister formation and linear complement C3 deposition along the basement membrane zone, and the serum anti-BP180 antibody level was found to be high on measurement. She was effectively treated with 50 mg/day of oral prednisolone. Her skin lesions disappeared, leaving pigmentation.

New aspects in the treatment of uterine leiomyoma associated with endometriosis

2017 ◽  
pp. 32-35
Author(s):  
V.V. Kaminskiy ◽  
◽  
E.V. Prokopovych ◽  
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Uterine Fibroids ◽  
Progesterone Receptors ◽  
Objective Evaluation ◽  
Treatment Method ◽  
Integrated Treatment ◽  
Uterine Myoma ◽  
Ulipristal Acetate ◽  
High Level

Despite the high level of development of modern surgery and pharmacology, none of the surgical techniques (hysterectomy / myometectomy or embolization of the uterine arteries) or drug therapy is not a guarantee of the absence of a future recurrence of uterine fibroids and endometriosis. However, there are methods of effective pharmacotherapy for their manifestations. In particular, selective progesterone receptor modulators (SMPR) demonstrate high efficacy in respect of the symptoms of myoma and the size of the nodes, which allows them to be considered as a complete alternative to the surgical treatment of uterine fibroids. The objective: evaluation of the effectiveness of the use of SMPR in the treatment of combined gynecological diseases. Patients and methods. The study included materials for the observation of 40 women 20–52 years old with uterine myoma against the background of combined gynecological pathology (endometriosis, infertility), which carried out the enucleation of myomatous nodes by laparotomy, laparoscopic or transcervical access. Patients were divided into two groups. In the main group (n=20), women received SMPR – ulipristal acetate (UPA) 5 mg daily for 3 months. The UIA's bioavailability is 70%. The optimal therapeutic single dose for the analyzed pathology is 5 mg. After 3 months, the first assessment of the effectiveness of the drug with combined gynecological pathology was conducted, then 14 women were exposed to surgical treatment, and 6 of 20 patients continued conservative treatment for another 1–4 months. After the operation to prevent the recurrence of uterine fibroids and endometriosis, 8 patients continued treatment of UPA for 4 months. In the comparison group (n=20), women underwent surgical treatment at similar rates, but the SMPR was not assigned to surgery. Results. Of the studies indicate that the use of such a selective modulator of progesterone receptors, like vandalite acetate, in the treatment of uterine myomas in combination with endometriosis is safe and well tolerated, leads to rapid persistent coping of uterine bleeding, a significant decrease in the size of nodes and foci of endometriosis, and the achieved The therapeutic effect is maintained even after the abolition of therapy. Conclusion. Thus, the use of the drug ulipristal acetate in the treatment of uterine fibroate on the background of combined gynecologic pathology is highly effective and promising as an independent and integrated treatment method of this category of patients. Key words: uterine myoma, endometriosis, selective modulators of progesterone receptors, viperpatel acetate, combined oral contraceptives.

Histopathological Diagnosis of Partial and Complete Hydatidiform Mole in the First Trimester of Pregnancy

2003 ◽  
Vol 6 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Neil J. Sebire ◽  
Rosemary A. Fisher ◽  
Helene C. Rees
Keyword(s):  
Early Pregnancy ◽  
Hydatidiform Mole ◽  
First Trimester ◽  
Histopathological Diagnosis ◽  
Molar Pregnancy ◽  
Diagnostic Problem ◽  
Complete Hydatidiform Mole ◽  
Products Of Conception ◽  
Genetic Abnormalities ◽  
First Trimester Of Pregnancy

The diagnosis of molar pregnancy is a continuing diagnostic problem for many practicing histopathologists who are required to examine specimens of products of conception, particularly since changes in gynecological management in recent years have resulted in uterine evacuation at earlier gestations. The aim of this review is to provide practical, up-to-date, diagnostically useful information regarding the histological diagnosis of molar disease in early pregnancy. Pathophysiological issues relevant to molar pregnancies, such as genetic abnormalities, will be briefly summarized, but nonhistopathological aspects of molar disease will not be covered in detail in this review.

scholarly journals Atypical presentation of molar pregnancy

2018 ◽  
pp. bcr-2018-225545
Author(s):  
Ream Langhe ◽  
Bogdan Alexandru Muresan ◽  
Etop Akpan ◽  
Nor Azlia Abdul Wahab
Keyword(s):  
Hydatidiform Mole ◽  
Abdominal Distension ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Products Of Conception ◽  
Good General Condition ◽  
Uterine Curettage

The classic features of molar pregnancy are irregular vaginal bleeding, hyperemesis, enlarged uterus for gestational age and early failed pregnancy. Less common presentations include hyperthyroidism, early onset pre-eclampsia or abdominal distension due to theca lutein cysts. Here, we present a case of molar pregnancy where a woman presented to the emergency department with symptoms of acute abdomen and was treated as ruptured ectopic pregnancy. The woman underwent laparoscopy and evacuation of retained products of conception. Histological examination of uterine curettage confirmed the diagnosis of a complete hydatidiform mole. The woman was discharged home in good general condition with a plan for serial beta-human chorionic gonadotropin (beta-hCG) follow-up. Complete follow-up includes use of contraception and follow-up after beta-hCG is negative for a year.

scholarly journals Coexistent molar pregnancy with a normal fetus-a rare presentation of gestational trophoblastic disease

2021 ◽  
Vol 10 (10) ◽  
pp. 3962
Author(s):  
Catarina J. Nascimento ◽  
Mariana Veiga ◽  
Ana Rita Silva ◽  
Joana Cominho
Keyword(s):  
Twin Pregnancy ◽  
Hydatidiform Mole ◽  
Healthy Woman ◽  
Clinical Approach ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Consensus Protocol ◽  
Rare Presentation ◽  
Normal Fetus ◽  
Increased Risk

A coexistent molar pregnancy with a normal fetus is rare, with an incidence of 1 in 22.000 to 100.000 pregnancies-only 200 cases reported in the last two decades. The ultrasound is essential for an earlier diagnosis, and the management of these cases is challenging due to the increased risk of obstetrics complications and the possibility of posterior gestational trophoblastic neoplasia. Here we describe a 33-year-old healthy woman with a first-trimester twin pregnancy, presented with a normal fetus and a heterogeneous and vacuolar structure suggestive of complete hydatidiform mole. The pregnancy was interrupted, and a histological diagnosis confirmed complete hydatidiform mole in dichorionic/diamniotic twin pregnancy at 14 weeks. Molar twin pregnancy is a rare condition, and do not exist any consensus protocol to guide the clinical approach, so the decision to continue the pregnancy depends on the couple’s desire and maternal and fetal complications.

scholarly journals Clinicopathological study of Gestational Trophoblastic Disease

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2344-2349
Author(s):  
Ramesh M. Oswal ◽  
Mahendra A. Patil ◽  
Sujata M. Kumbhar ◽  
Jyoti S. Tele ◽  
Atul B. Hulwan
Keyword(s):  
Risk Factors ◽  
Maternal Age ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Histopathological Study ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
Complete Mole ◽  
Clinicopathological Study

Several potential etiologic risk factors have been evaluated for the development of complete hydatidiform mole. The two established risk factors that have emerged are extremes of maternal age and prior molar pregnancy. Advanced or very young maternal age has consistently correlated with higher rates of complete hydatidiform mole. Compared to women aged 21- 35 years, the risk of a complete mole is 1.9 times higher for women both more than 35 years and less than 21 years as well as 7.5 times higher for women more than 40 years. (49, 50) The risk of repeat molar pregnancy after 1 mole is about 1% or about 10-20 times the risk for the general population. The present study on the gestational trophoblastic disease (GTD) was carried out as it is one of the fascinating gynaecological tumours. Hence a clinicopathological study of gestational trophoblastic disease was undertaken with relevance to the histopathological study of GTD and clinical correlation.

Diagnostic Utility of Microsatellite Genotyping for Molar Pregnancy Testing

2013 ◽  
Vol 137 (1) ◽  
pp. 55-63 ◽  
Author(s):  
Larissa V. Furtado ◽  
Christian N. Paxton ◽  
Mohamed A. Jama ◽  
Sheryl R. Tripp ◽  
Andrew R. Wilson ◽  
...  
Keyword(s):  
Tandem Repeats ◽  
Hydatidiform Mole ◽  
Molar Pregnancy ◽  
Microsatellite Genotyping ◽  
Complete Hydatidiform Mole ◽  
Dna Microsatellites ◽  
Partial Hydatidiform Mole ◽  
Str Markers ◽  
Genetic Abnormalities ◽  
Pregnancy Testing

Context.—Molecular genotyping by analysis of DNA microsatellites, also known as short tandem repeats (STRs), is an established method for diagnosing and classifying hydatidiform mole. Distinction of both complete hydatidiform mole and partial hydatidiform mole from nonmolar specimens is relevant for clinical management owing to differences in risk for persistent gestational trophoblastic disease. Objective.—To determine the technical performance of microsatellite genotyping by using a commercially available multiplex assay, and to describe the application of additional methods to confirm other genetic abnormalities detected by the genotyping assay. Design.—Microsatellite genotyping data on 102 cases referred for molar pregnancy testing are presented. A separate panel of mini STR markers, flow cytometry, fluorescence in situ hybridization, and p57 immunohistochemistry were used to characterize cases with other incidental genetic abnormalities. Results.—Forty-eight cases were classified as hydatidiform mole (31, complete hydatidiform mole; 17, partial hydatidiform mole). Genotyping also revealed 11 cases of suspected trisomy and 1 case of androgenetic/biparental mosaicism. Trisomy for selected chromosomes (13, 16, 18, and 21) was confirmed in all cases by using a panel of mini STR markers. Conclusions.—This series illustrates the utility of microsatellite genotyping as a stand-alone method for accurate classification of hydatidiform mole. Other genetic abnormalities may be detected by genotyping; confirmation of the suspected abnormality requires additional testing.

scholarly journals Expression of Pro-Apoptotic Bax and Anti-Apoptotic Bcl-2 Proteins in Hydatidiform Moles and Placentas With Hydropic Changes

2019 ◽  
Author(s):  
Alireza Khooei ◽  
Fatemeh Atabaki Pasdar ◽  
Alireza Fazel ◽  
Mahmoud Mahmoudi ◽  
Mohammad Reza Nikravesh ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Tool ◽  
Stromal Cells ◽  
Hydatidiform Mole ◽  
Complete Hydatidiform Mole ◽  
Tissue Samples ◽  
Partial Hydatidiform Mole ◽  
Significant Difference ◽  
Hydropic Abortion ◽  
Hydatidiform Moles

Abstract- Morphologic examination still forms the main diagnostic tool in the differential diagnosis of molar placentas. However the criteria are subjective and show considerable inter-observer variability among pathologists. The aim of the present study was to investigate the role of Bcl-2 and Bax immunostaining in the differential diagnosis of molar placentas. Bax and Bcl-2 immunohistochemical staining were performed in 19 molars (8 partial and 11 complete hydatidiform mole) and 10 non-molar (hydropic abortion) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry had confirmed diploidy in hydropic abortions and complete hydatidiform moles and triploidy in partial hydatidiform moles. Bcl-2 expression was observed only in syncytiotrophoblasts, No immunoreactivity was detected in Cytotrophoblasts, and stromal cells, the total score averages of Bcl-2 immunoexpression in partial hydatidiform moles and hydropic abortions were significantly higher than in complete hydatidiform moles, whereas no significant difference was observed between partial hydatidiform moles and hydropic abortions. Bax immunoreactivity was observed in cytotrophoblasts, stromal cells and occasionally in syncytiotrophoblasts. No statistically significant difference in Bax immunoexpression total score was observed among various groups. Based on the results of this study, Bcl-2 immunostaining offers a potential adjunctive diagnostic tool to distinguish complete hydatidiform mole from partial hydatidiform mole and hydropic abortion, but not partial hydatidiform mole from hydropic abortion, Bax immunostaining cannot be helpful in this regard.

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