scholarly journals Recurrent Hydatidiform Mole: A Case Report of Five Consecutive Molar Pregnancies Complicated by Thyrotoxicosis and Review of Literature

2019 ◽  
Vol 34 (1) ◽  
pp. 52-55
Author(s):  
Sabera Khatun
Keyword(s):  
Case Report ◽  
Hydatidiform Mole ◽  
Total Abdominal Hysterectomy ◽  
Normal Pregnancy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Base Hospital ◽  
Diagnostic Work

Hydatidiform mole (HM) is the most common form of Gestational Trophoblastic Disease (GTD). Recurrence of HM is extremely rare. Here we report the case report of a patient with five consecutive complete hydatidiform moles without any normal pregnancy. A 41-years old lady, was referred to Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with H/O repeated molar pregnancies. Her first molar pregnancy was in 2005, second in 2006, third in 2007 & fourth in 2014. All the molar pregnancies were managed by suction evacuation at her base hospital. Following evacuation of 4th molar pregnancy at base hospital, she was referred to BSMMU for subsequent management. Regular follow-up was done using molar card. All the pregnancies were complete hydatidiform mole (CHM) and were confirmed clinically and sonographically. None of the molar pregnancies needed treatment with chemotherapy. During her fifth molar pregnancy she developed shortness of breath and palpitation. Diagnostic work up in our hospital confirmed complete molar pregnancy with thyrotoxicosis, for which she received b-blocker agent and after normalization of thyrotoxicosis, she underwent total abdominal hysterectomy on 11. 10. 18. Now she is on regular follow up by serum bhCG and has no complication. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 52-55

scholarly journals The Controversy of Hydatidiform Mole Treatment In Women age ≥ 40 year-old

Medicinus ◽  
2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Gabriella Farah ◽  
Julita D.L Nainggolan
Keyword(s):  
Older Patients ◽  
Economic Status ◽  
Hydatidiform Mole ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Primary Treatment ◽  
Molar Pregnancy ◽  
Recommended Treatment ◽  
Suction Curettage

<p>Background: Hydatidiform mole or commonly known as molar pregnancy is one of the gestational trophoblastic disease (GTD) caused by an abnormal trophoblast proliferation. About 50% of gestational trophoblast neoplasm (GTN) arises from molar pregnancy. Higher risk of GTN was found in older patient, especially women age ≥40 years old. Management of hydatidiform mole is often faced come challenges, especially in developing country like Indonesia. Although, suction curettage is the most recommended treatment for the evacuation of molar pregnancy, hysterectomy is considerable for women who have completed childbirth and do not wish to preserve their fertility.<br />Case: Here we present case of 48 years old women with hydatidiform mole. Considering the age of the patient and the completion of her childbearing, we decided to do a laparotomy total abdominal hysterectomy for the evacuation of the mole instead of suction curettage. Turned out that this patient had an invasive mole, one of the types of gestational trophoblastic neoplasia.<br />Conclusion: Although suction curettage is the most frequent technique for molar evacuation, hysterectomy is a reasonable option as primary treatment to be performed in older patients and for those who do not wish to preserve their fertility. The other important points such as socio-economic status, education level, and geographical issues should be considered also on managing older patients with hydatidiform mole in developing countries</p>

scholarly journals Coriocarcinoma gestacional primario de cuello uterino. Presentación de un caso

2021 ◽  
Vol 81 (04) ◽  
pp. 406-410
Author(s):  
Viviana García ◽  
◽  
Franco Calderaro Di Ruggiero ◽  
Jorge Hoegl ◽  
Carlos Quintero ◽  
...  
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
World Health ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Gestational Choriocarcinoma ◽  
Gynecology And Obstetrics ◽  
Gynecological Examination

Choriocarcinoma represents a type of malignant tumor of gestational trophoblastic disease. It can develop after a molar pregnancy, miscarriage, normal or ectopic pregnancy. Generally its seat site is the uterine body; infrequent places such as the cervix have been described. We report the case of a 37-year-old patient is reported, VI gestations IV deliveries I cesarean section I molar pregnancy, with abnormal uterine bleeding, which is referred to the Hospital Oncology Service. On gynecological examination, an exophytic mass is observed in the cervix. A biopsy was taken that reported: Gestational choriocarcinoma and plasma levels of β-hCG were verified: 13805 IU / L. A total abdominal hysterectomy was performed with preservation of the ovaries. It was concluded as stage I of the International Federation of Gynecology and Obstetrics and 8, according to the score of the World Health Organization (ST I: 8), for which adjuvant was indicated. Currently no evidence of disease. Keywords: Choriocarcinoma, gestational trophoblastic disease, cervix.

Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: A case report

2003 ◽  
Vol 13 (2) ◽  
pp. 246-248
Author(s):  
M. Moodley ◽  
J. Moodley
Keyword(s):  
Case Report ◽  
Antiretroviral Therapy ◽  
Young Women ◽  
Ethical Dilemmas ◽  
Gestational Trophoblastic Disease ◽  
Cytotoxic Chemotherapy ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Response To Chemotherapy

Due to the HIV pandemic, the chances of finding gynecological malignancies in HIV-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. Gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD4 counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD4 count. She was given antiretroviral therapy and once the CD4 count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum βHCG level and CD4 count above 200. We conclude that HIV-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity.

scholarly journals SUN-513 Severe Hyperthyroidism in a Complete Molar Pregnancy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nikoletta Proudan ◽  
Kersthine Andre
Keyword(s):  
Perioperative Complications ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Storm ◽  
Molar Pregnancy ◽  
Free T4 ◽  
Trophoblastic Disease ◽  
Increased Risk ◽  
History Of

Abstract Hydatidiform mole (HM), a type of gestational trophoblastic disease (GTD), is a rare cause of clinical hyperthyroidism. The development of hyperthyroidism requires an elevation of HCG &gt;100,000 mlU/mL for several weeks. Complete mole has a marked HCG elevation compared to partial mole thus presents with a higher incidence of thyrotoxicosis. Surgical uterine evacuation is the treatment of choice for HM. However, untreated hyperthyroidism can pose a risk for the development of thyroid storm and high-output cardiac failure in the perioperative period. To our knowledge, there are no specific guidelines for management at this time. We present a case of hyperthyroidism secondary to complete molar pregnancy successfully treated with propylthiouracil (PTU), potassium iodide (SSKI), and atenolol in the preoperative period. A 42-year-old female with history of migraines presented to her gynecologist with a 3-week history of lower abdominal cramping, vomiting, loss of appetite, and abnormal vaginal bleeding. She also endorsed a 6-pound weight loss, intermittent tachycardia, exertional dyspnea, and increased anxiety. Pregnancy test was positive, and ultrasound was concerning for GTD. Laboratory work up was significant for HCG 797,747 mIU/mL (&lt; 5mlU/mL), TSH &lt;0.005 mIU/mL (0.4-4.0 mlU/mL), Free T4 3.09 ng/dL (0.9-1.9 ng/dL), and Free T3 11.48 pg/dL (1.76-3.78 pg/dL). The patient was admitted to the hospital and started on PTU 100 mg Q6H, SSKI 200 mg TID following the first dose of PTU, and atenolol 25 mg daily. She underwent an uncomplicated D & C the next day. On post-op day 1, HCG decreased to 195,338 mIU/mL and Free T4 to 2.39 ng/dL. The patient was discharged on the aforementioned doses of PTU and atenolol. One-week follow-up labs showed HCG 8,917 mIU/mL and Free T4 1.22 ng/dL. Surgical pathology confirmed a complete hydatidiform mole. PTU was decreased to 50 mg TID. On post-op day 14, HCG had risen to 15,395 mIU/mL with onset of nausea and vomiting. Repeat Free T4 remained within reference range. Patient was taken back to surgery for a laparoscopic total hysterectomy with bilateral salpingectomy. Pathology confirmed an invasive hydatidiform mole. Two-week follow-up lab work showed HCG 155 mIU/mL, TSH 1.5 mIU/mL, and Free T4 1.19 ng/dL. PTU and atenolol were then discontinued. The development of hyperthyroidism in molar pregnancy is largely influenced by the level of HCG and usually resolves with treatment of GTD (1). However, it’s crucial to control thyrotoxicosis to avoid perioperative complications. This case also highlights the importance of monitoring HCG levels following a complete molar pregnancy due to an increased risk for invasive neoplasm. 1. Walkington, L et al. “Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease.” British journal of cancer vol. 104,11 (2011): 1665-9. doi:10.1038/bjc.2011.139

scholarly journals A hydatidiform mole in a postmenopausal woman

2018 ◽  
Vol 7 (6) ◽  
pp. 2500
Author(s):  
Mohana Dhanapal ◽  
. Padmapriya ◽  
Anbarasi Pandian
Keyword(s):  
Postmenopausal Woman ◽  
Elderly Women ◽  
Hydatidiform Mole ◽  
Total Abdominal Hysterectomy ◽  
The Elderly ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Reproductive Age ◽  
Trophoblastic Cell ◽  
Trophoblastic Disease

Gestational trophoblastic disease occurs in less than 1 per 1200 pregnancies. The spectrum of this disease ranges from benign hydatidiform mole to trophoblastic malignancy (placental-site trophoblastic tumor and choriocarcinoma). Benign gestational trophoblastic disease generally occurs in women of reproductive age and is extremely rare in postmenopausal women. We report a case of a 54-year-old postmenopausal woman who underwent an emergency total abdominal hysterectomy due to uncontrollable vaginal bleeding associated with an increased serum β-human chorionic gonadotropin level. The resected uterus contained an endometrial, cystic, grapelike tumor. Microscopic examination demonstrated hydropic degenerated villi with a circumferential trophoblastic cell proliferation and moderate atypia, consistent with a complete hydatidiform mole. Only isolated cases of hydatiform mole in elderly women have been reported in literature. But there still remains a risk of developing gestational trophoblastic disease in the elderly and it should always be included in the differential diagnosis of postmenopausal bleed.

scholarly journals TUBAL HYDATIDIFORM MOLE: A CASE REPORT

2021 ◽  
Vol 9 (01) ◽  
pp. 646-649
Author(s):  
B. Mouhamed Mahmoud ◽  
◽  
N. Abdelkader ◽  
M. Mohamed Lemine ◽  
K. Saoud N. Mamouni ◽  
...  
Keyword(s):  
Case Report ◽  
Hemorrhagic Shock ◽  
Histological Examination ◽  
Hydatidiform Mole ◽  
Metastatic Potential ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Surgical Specimen ◽  
Trophoblastic Disease

Gestational trophoblastic disease (MTG) groups together conditions that are very variable from a clinical, biological and metastatic potential point of view.We report a case of ruptured molar pregnancy, diagnosed by a picture of hemorrhagic shock, and confirmed by histological examination of the surgical specimen. Monitoring was by assaying plasma BhCG levels.

scholarly journals MOLAR ECTOPIC PREGNANCY;

2013 ◽  
Vol 20 (04) ◽  
pp. 638-641
Author(s):  
SHAMA CHAUDHARY ◽  
IQRA JANGDA ◽  
RUBINA HUSSAIN
Keyword(s):  
Ectopic Pregnancy ◽  
Iliac Fossa ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Beta Hcg ◽  
History Of ◽  
The Right

Ectopic molar pregnancy is a rare occurrence. Clinical diagnosis of a molar pregnancy is difficult but histopathology is thegold standard for diagnosis. The management of ectopic molar pregnancies consists of surgically removing the conceptus, follow up &chemotherapy, if required. We are reporting a case report of a 35-year-old married, nulliparous woman, admitted in emergency with a 6-week history of amenorrhea, severe abdominal pain & an episode of fainting at home. Per abdominal examination revealed tendernessover the right iliac fossa, with guarding & rigidity. Diagnosis of ruptured ectopic pregnancy was made.Emergency laparotomy was done.Histopathological examination, showed tubal ectopic pregnancy with partial hydatidiform mole & a separate corpus luteal cyst.She wasfollowed up with serial beta hCG which became normal within 1 month. Although ectopic molar pregnancy is a rare entity but all ectopicpregnancies should be examined histologically to rule out presence of gestational trophoblastic disease to plan follow-up accordingly inorder to avoid persistent gestational trophoblastic disease which has a chance of malignant conversion.The prognosis of ectopic molarpregnancies is the same as for other forms of gestational trophoblastic disease.

scholarly journals Clinical Presentation and Management of Hydatidiform Mole in a Peripheral Tertiary Hospital

2013 ◽  
Vol 25 (2) ◽  
pp. 59-64
Author(s):  
Jaglul Haider Khan ◽  
Jannatul Ferdous ◽  
Samiya Alam
Keyword(s):  
Clinical Presentation ◽  
Economic Status ◽  
Hydatidiform Mole ◽  
Tertiary Hospital ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
College Hospital ◽  
Medical College ◽  
Abnormal Vaginal Bleeding

This study was conducted in Faridpur Medical College Hospital, Faridpur, from January 2008  to December 2008 among fifty patients, diagnosed as a case of molar pregnancy. Incidenc of  molar pregnancy was 8.27 per thousand pregnancy. Sixty percent of the patients were multiparous  and eighty percent of low socio economic status . B positive blood group was prevalent (36%)  in this study.Sixty percent( 60%) of the patients presented with amenorrhoea and abnormal  vaginal bleeding.. Most of the patients (72%) were treated with suction evacuation and curettage.  Of them hemorrhage was the most common immediate complication (80%). Complication  like shock and perforation during evacuation was 14% and 4% respectively. Three patient  (6%) developed Persistent Gestational Trophoblastic Disease(GTD) and one (2%) patient  developed choriocarcinoma with lung metastasis and died. Thirty two (64%) patients attended  for regular follow up but ten patients (20%) had attended irregularly and eight patients (16%)  had dropped out .This study shows that follow up for molar pregnancy cases is not satisfactory  in a district medical college hospital.Further improvement can be done by increasing awareness  of the patients. DOI: http://dx.doi.org/10.3329/bjog.v25i2.13741 Bangladesh J Obstet Gynaecol, 2010; Vol. 25(2) : 59-64  

scholarly journals Persistent Gestational Trophoblastic Disease following Ovarian Molar Pregnancy: A Case report of A Rare Entity with Review of the Literature

2021 ◽  
Author(s):  
Bibechan Thapa ◽  
Meenu Maharjan ◽  
Heera Tuladhar
Keyword(s):  
Case Report ◽  
Gestational Trophoblastic Disease ◽  
Chorionic Gonadotrophin ◽  
Human Chorionic Gonadotrophin ◽  
Molar Pregnancy ◽  
Rare Entity ◽  
Review Of The Literature ◽  
Trophoblastic Disease ◽  
Beta Human Chorionic Gonadotrophin

Ovarian molar pregnancy, though a very rare entity, behaves like any other molar pregnancy. After surgical management, close follow-up with Beta Human Chorionic Gonadotrophin surveillance is invariable to detect progression to persistent Gestational Trophoblastic Disease, which if develops can be treated successfully with chemotherapy.

Normalisation of human chorionic gonadotrophin (hCG) levels in a patient with partial molar pregnancy with a uterine mass without chemotherapy: impact of using herbal remedies

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Norzila Ismail ◽  
Aida Maziha Zainudin ◽  
Gan Siew Hua
Keyword(s):  
Hydatidiform Mole ◽  
Abdominal Ultrasound ◽  
Massive Bleeding ◽  
Chorionic Gonadotrophin ◽  
Human Chorionic Gonadotrophin ◽  
Herbal Remedies ◽  
Lung Field ◽  
Molar Pregnancy ◽  
Brucea Javanica

Abstract Objectives Level of βhCG and the presence of any uterine mass of hydatidiform mole need a careful review or monitoring in order to prevent metastasis, provide an early treatment and avoid unnecessary chemotherapy. Case presentation A 36-year old fifth gravida patient who had a missed abortion was diagnosed as having a molar pregnancy with beta human chorionic gonadotrophin (βhCG) level of 509,921 IU/L. Her lung field was clear and she underwent suction and curettage (S & C) procedure. However, after six weeks, AA presented to the emergency department with a massive bleeding, although her βhCG level had decreased to 65,770 IU/L. A trans-abdominal ultrasound indicated the presence of an intra-uterine mass (3.0 × 4.4 cm). Nevertheless, her βhCG continued to show a declining trend (8,426 IU/L). AA was advised to undergo a chemotherapy but she refused, citing preference for alternative medicine like herbs instead. She opted for an “at own risk” (AOR) discharge with scheduled follow up. Subsequently, her condition improved with her βhCG showing a downward trend. Surprisingly, at six months post S & C, her βhCG ameliorated to 0 IU/L with no mass detected by ultrasound. Conclusions Brucea javanica fruits, Pereskia bleo and Annona muricata leaves can potentially be useful alternatives to chemotherapy and need further studies.

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