scholarly journals Cervical Hydatidiform Moles Pregnancy: Diagnosis and Treatment

2021 ◽  
Vol 9 (C) ◽  
pp. 291-296
Author(s):  
I Gede Sastra Winata ◽  
Popy Kusuardiyanto ◽  
Made Bagus Dwi Aryana ◽  
Ryan Mulyana
Keyword(s):  
Hydatidiform Mole ◽  
Rare Condition ◽  
Arterial Ligation ◽  
Partial Hydatidiform Mole ◽  
Pregnancy Diagnosis ◽  
Beta Hcg ◽  
Diagnosis Therapy ◽  
Mass Evacuation ◽  
Hydatidiform Moles ◽  
Blighted Ovum

Cervical partial hydatidiform mole is a rare condition and difficult to diagnose. A 39-year-old Balinese woman from Sanglah General Hospital, Bali, Indonesia complained vaginal bleeding with abdominal pain. The patient was diagnosed with a partial hydatidiform mole based on physical examination, ultrasound, beta HCG levels and pathology examinations. Mass evacuation surgery followed by arterial ligation to stop the bleeding and periodically examination of beta HCG levels was carried out until the 14th week after the procedure. Beta HCG decreased gradually to normal level and indicate no risk of trophoblastic malignancy. Establishing the early diagnosis significantly affects the outcome of patient. Keywords: partial cervical hydatidiform mole, blighted ovum, pregnancy, diagnosis, therapy.

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.

scholarly journals Medical termination of a partial hydatidiform mole with coexisting fetus during second trimester; management dilemma: a case report

2020 ◽  
Vol 9 (12) ◽  
pp. 5172
Author(s):  
Jharna Behura ◽  
Mohini Paul ◽  
Ankit Seth ◽  
Aafreen Naaz
Keyword(s):  
Caesarean Section ◽  
Hydatidiform Mole ◽  
Cardiac Activity ◽  
Rare Condition ◽  
Medical Abortion ◽  
Second Trimester ◽  
Partial Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
Medical Termination

Partial hydatidiform mole and coexisting foetus is a rare condition, with an incidence of 122,000-1,000,000 pregnancies. It presents a dilemma for obstetricians when detected in second trimester of pregnancy. Medical termination is effective during second trimester; however, it increases the risk of occurrence of persistent trophoblastic disease. Following a review of literature, it was seen that most of the PHMCF terminated by medical induction during second trimester resulted in the development of PTD and lung metastasis. However, cases terminated by caesarean section during the third trimester did not develop PTD or metastasis. A 34 year old woman, gravida 3 para 2 at 25 weeks and 3 days of gestation, presented with absent fetal movements. She was markedly pale. She had no prior antenatal visits. Ultrasound examination revealed a single intrauterine foetus at 23 weeks of gestation with no cardiac activity. Spalding sign was positive. Liquor was reduced and showed internal echoes, secondary to intramniotic bleed. Placenta was grossly enlarged, anterior in location with multiple cystic areas suggestive of a partial mole. As her haemoglobin was 5.6 grams, she was transfused with 3 units of packed cells. The patient underwent induced medical abortion after counselling for risk of persistent trophoblastic disease and long term follow up. She was followed up with weekly serial serum beta hCG monitoring, which returned to normal within a month. She showed no signs of persistent trophoblastic disease at 3 months follow up and has been advised to continue follow up for a year. Mid-trimester termination of pregnancy due to PHMCF is challenging due to high risk of PTD and metastasis associated with it. Performance of caesarean section is not recommended during second trimester of pregnancy but is a relatively safer strategy to avoid the risks of persistent trophoblastic disease.

Partial Hydatidiform Mole with a Live Fetus— A Rare Entity

2009 ◽  
Vol 1 (3) ◽  
pp. 77-79
Author(s):  
Mahesh Koregol ◽  
Mrutyunjaya Bellad ◽  
Chandana Malapati
Keyword(s):  
Preterm Labor ◽  
Histopathological Examination ◽  
Hydatidiform Mole ◽  
Rare Condition ◽  
Fetal Tissue ◽  
Partial Hydatidiform Mole ◽  
Partial Mole ◽  
Live Fetus ◽  
Live Baby ◽  
Rule Out

ABSTRACT Partial hydatidiform mole (PHM) with a singleton live fetus is a rare condition. A live baby of 2000 grams with many external congenital anomalies like hydrocephalus, bilateral congenital talipus equino varus (CTEV), meningomyelocele and spina bifida was delivered. Placenta weighed 700 grams and PHM was confirmed by histopathological examination. Baby expired one hour after birth. Baby was sent for autopsy which documented various anomalies. Partial hydatidiform mole is a histopathological entity characterized by focal trophoblastic hyperplasia with villous hydrops together with identifiable fetal tissue. PHM with a single live fetus is a rare condition which is reported by very few authors. Not all the cases of partial mole can be detected by USG/Doppler. If any anomalies are detected, PHM should be thought among the conditions possible. MShCG and karyotyping can be done to rule out this condition. Placenta has to be sent for histopathological examination to confirm the diagnosis of PHM. These patients are prone to go in preterm labor and preterm premature rupture of membranes (PPROM). There is possibility of malpresentations like transverse lie among these cases.

scholarly journals Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects

2018 ◽  
Vol 40 (05) ◽  
pp. 294-299 ◽  
Author(s):  
Consuelo López ◽  
Vania Lopes ◽  
Fabiana Resende ◽  
Jessica Steim ◽  
Lilian Padrón ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Fallopian Tube ◽  
Present Report ◽  
Hydatidiform Mole ◽  
Rare Condition ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
The Past ◽  
Cure Rates ◽  
Hydatidiform Moles

AbstractThis 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.

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

Partial Hydatidiform Mole

1993 ◽  
Vol 12 (4) ◽  
pp. 315-323 ◽  
Author(s):  
M. D. Jeffers ◽  
P. OʼDwyer ◽  
B. Curran ◽  
M. Leader ◽  
J. E. Gillan
Keyword(s):  
Hydatidiform Mole ◽  
Partial Hydatidiform Mole

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.

scholarly journals Genetics, molar pregnancies and medieval ideas of monstrous births: the lump of flesh in The King of Tars

2018 ◽  
Vol 45 (1) ◽  
pp. 2-9
Author(s):  
Natalie Goodison ◽  
Deborah J G Mackay ◽  
I Karen Temple
Keyword(s):  
Hydatidiform Mole ◽  
Seed Transmission ◽  
Warning Sign ◽  
Parental Contribution ◽  
Medieval Text ◽  
Hydatidiform Moles

The medieval English romance The King of Tars gives an account of a birth of a lump of flesh. This has been considered as fantastic and monstrous in past literature, the horrific union of a Christian and Saracen. However, while the text certainly speaks to miscegenation, we propose that this lump of flesh is actually a hydatidiform mole. We trace the hydatidiform mole from antiquity, surrounding it with contextual medieval examples, from theology, history and medicine, that also describe abnormal births as ‘lumps of flesh’. By discussing medieval ideas of monsters as a warning sign, we interpret the lump of flesh in terms of abnormal births, seed transmission, parental contribution and sin. Ideas of warning, blame and intervention present themselves as a response to moles both in medieval texts as well as in modern reactions to hydatidiform moles. We explore the epigenetics of hydatidiform moles and relate them to the medieval text. In The King of Tars, the fault for the lump of flesh could reside with either parent; we find that this is also the case in the genetic formation of the hydatidiform mole; we also argue that the epigenetics supports medieval theories of seed transmission.

Clinical Utility of Hyperglycosylated hCG in Serum Taken before Hydatidiform Mole Evacuation to Predict Persistent Trophoblastic Disease

2006 ◽  
Vol 21 (1) ◽  
pp. 45-49 ◽  
Author(s):  
H. Ngo Duc ◽  
N.E. van Trommel ◽  
F.C.G.J. Sweep ◽  
L.F.A.G. Massuger ◽  
C.M.G. Thomas
Keyword(s):  
Diagnostic Accuracy ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Hydatidiform Mole ◽  
Subsequent Development ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Trophoblastic Disease ◽  
Central Registry ◽  
Hydatidiform Moles

Objective Human chorionic gonadotropin (hCG) is widely used in the management of hydatidiform mole and persistent trophoblastic disease (PTD). Studies on hyperglycosylated human chorionic gonadotropin (invasive trophoblast antigen, ITA) in PTD are limited. In serum samples taken before evacuation of molar pregnancies we measured the concentrations of free hCG β-subunit (free hCGβ), “total” hCG (hCG+hCGβ) and ITA, and determined whether ITA, the two other hCG analytes, or the calculated ratios of hCGβ/hCG+hCGβ, hCGβ/ITA and hCG+hCGβ/ITA could predict the later development of PTD. Design A retrospective study based on blood specimens collected in the Dutch Central Registry for Hydatidiform Moles. The study group comprised 97 patients with hydatidiform moles who did not develop PTD after mole evacuation and 33 patients who did develop PTD. Methods Serum samples from 130 patients with hydatidiform mole with or without PTD were assayed using specific (radio)immunoassays for free hCGβ, total hCG, and ITA. From these analytes we also calculated the ratios hCGβ/hCG+hCGβ, hCGβ/ITA, and hCG+hCGβ/ITA. To predict the development of PTD from these analytes and parameters we performed receiver-operating characteristic (ROC) curve analysis, resulting in areas under the curve (AUCs) that represented the diagnostic accuracy which was rated in a range from excellent (AUC >0.9 or <0.1) to poor (AUC 0.4–0.6). Results The diagnostic accuracy of ITA was moderate (0.618) and not different from that of free hCGβ (0.610) and hCG+hCGβ (0.622). Conclusions ITA as well as the other analytes and parameters in serum taken prior to evacuation from patients with molar pregnancies cannot be used to predict the subsequent development of persistent trophoblastic disease.

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