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Suraj 23 H Mole

Gestational trophoblastic diseases (GTDs) primarily include hydatidiform moles, which can be complete (absent fetus) or partial (abnormal fetus) and occur in approximately 1 in 1000-2000 pregnancies. Complete moles typically present as a 'snowstorm' appearance on ultrasound, while partial moles show an enlarged placenta with cystic spaces and may have a growth-retarded fetus. Treatment involves evacuation and monitoring of serum hCG levels, with potential complications including invasive moles and choriocarcinoma, a highly aggressive malignancy associated with rising β-hCG levels post-molar evacuation.

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23 views3 pages

Suraj 23 H Mole

Gestational trophoblastic diseases (GTDs) primarily include hydatidiform moles, which can be complete (absent fetus) or partial (abnormal fetus) and occur in approximately 1 in 1000-2000 pregnancies. Complete moles typically present as a 'snowstorm' appearance on ultrasound, while partial moles show an enlarged placenta with cystic spaces and may have a growth-retarded fetus. Treatment involves evacuation and monitoring of serum hCG levels, with potential complications including invasive moles and choriocarcinoma, a highly aggressive malignancy associated with rising β-hCG levels post-molar evacuation.

Uploaded by

prabin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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GTDs: Abnormal neoplastic proliferation of placental trophoblasts.

Hydatiform mole

 Most common of the GTDs.


 1 in every 1000-2000 pregnancies
 Can occur in pregnant women of any age ; highly prevalent in pregnant teen mothers and
between age 40-50 years.
 Can be complete or partial depending upon presence or absence of fetus.
 Complete mole-absent fetus
 Partial mole- abnormal fetus or absent fetus
 Rarely moles co-exist with a normal pregnancy (co-existent molar pregnancy)

Chromosomal composition:

 Complete H.mole- 46XXY (single sperm fertilizes egg that has lost its chromosomes)
 Partial H. mole – 69XXY (fertilization of a normal egg by two sperms)

Location: Uterus; rarely ovaries or fallopian tubes, chorionic villi are converted to mass of clear
vesicles that resemble bunch of grapes.

Risk factors:

 Moles are more common in ages over 40, and prior moles makes you more likely to get
another mole.

Complete Mole (classic mole) (70%): This one involves the entire placenta. There will be no
fetus. The worthless trivia is that the karyotype is diploid. The pathogenesis is fertilization of an
egg that has lost its chromosomes (46, XX).

First Trimester US: Classically shows the uterus to be filled with an echogenic, solid, highly
vascular mass, often described as “snowstorm” in appearance.
 May be difficult to diagnose in the first trimester
o may appear similar to a normal pregnancy or as an empty gestational sac
o <50% are diagnosed in the first trimester

Second Trimester US: Vesicles that make up the mole enlarge into individual cysts (2-30 mm)
and produce your “bunch of grapes” appearance.
Bilateral theca lutein cysts may also be seen on ultrasound.
CT: low resolution for assessment, hypoattenuating regions surrounding by enhancing
myometrium.

MRI: MRI may demonstrate a heterogeneous mass with cystic spaces distending the uterine
cavity. Fetal parts are notably absent.

 T1: there may be areas of high signal corresponding to foci of hemorrhage


 T2: there is heterogeneous high signal from the cystic spaces
 T1 C+ (Gd): often demonstrates intense enhancement due to hypervascularity

Partial Mole (30%): This one involves only a portion of the placenta. You do have a fetus, but
it’s all jacked up (triploid in karyotype). The pathogenesis is fertilization of an ovum by two
sperm (69, XXY(70%)/XXX(27%)/XYY(3%)). It’s lethal to the fetus. Less likely to progress to
choriocarcinoma.

US: The placenta will be enlarged, and have areas of multiple, diffuse anechoic lesions , cystic
spaces. Well-formed but growth-retarded fetus, either dead or alive with hydropic degeneration of fetal parts
being frequently present. Theca Lutein cysts may be +. Most commonly bilateral and seen in the
second trimester.
Some partial moles can have sonographic appearances indistinguishable from those of the
common complete moles or missed abortions, although an echogenic rim around the sac, as
found in missed abortion or blighted ovum, is notably absent.

CT: CT evaluation is not usually performed given its low resolution for the uterine assessment.
CT may show an enlarged uterus with areas of low attenuation, or hypoattenuating foci
surrounded by highly enhanced areas in the myometrium.

MRI: MRI can be used to determine if there is an extension of molar tissue outside the uterus.

Treatment and prognosis: When a partial mole is suspected and there is a live fetus, counseling
and genetic tests looking for triploidy should be offered (chorionic villus
sampling or amniocentesis).
Suction and curettage are used for evacuation and close follow-up of serum hCG levels for 6
months.
Buzzwords: Enlarged uterus, markedly elevated B-hCG, hyperemesis , theca lutein cysts

Invasive Mole
This refers to invasion of molar tissue into the myometrium. You typically see it after the
treatment of a hydatidiform mole (about 10% of cases). US may show echogenic tissue in
the myometrium. However, MRI is way better at demonstrating muscle invasion. MRI is going
to demonstrate focal myometrial masses, dilated vessels, and areas of hemorrhage and
necrosis.

Choriocarcinoma
This is a very aggressive malignancy that forms only trophoblasts (no villous structure).
Spread locally (into the myometrium and parametrium) then to spread hematogenous to any site
in the body. Very vascular and bleeds. The classic clinical scenario is serum β-hCG levels that
rise in the 8 to 10 weeks following evacuation of molar pregnancy. On ultrasound,
choriocarcinoma (at any site) results in a highly echogenic solid mass. Treatment =
methotrexate.

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