Diagnóstico y tratamiento quirúrgico de una paciente con una neoplasia trofoblástica gestacional / Diagnosis and surgical treatment of a patient with gestational trophoblastic neoplasia

Resumen ANTECEDENTE: La neoplasia trofoblástica gestacional forma parte del grupo de afecciones derivadas de la proliferación anómala del trofoblasto con capacidad para invasión y metástasis. CASO CLÍNICO: Paciente de 42 años, asintomática, con sospecha ecográfica de mola hidatiforme. El legrado uterino y el estudio anatomopatológico confirmaron el diagnóstico de mola hidatiforme completa. Con la cuantificación consecutiva de tres elevaciones de la β-HCG se diagnosticó: neoplasia trofoblástica gestacional. Se estadificó en estadio I, bajo riesgo y ante el deseo genésico satisfecho la paciente aceptó la histerectomía más salpingectomía bilateral. En el seguimiento posterior la paciente se encontró asintomática, con determinaciones seriadas de b-HCG negativa y ecografías vaginales sin hallazgos. CONCLUSIÓN: La histerectomía con salpingectomía bilateral puede ser el tratamiento definitivo en casos seleccionados de neoplasia trofoblástica. La evidencia disponible es escasa, por lo que es necesario seguir investigando en este campo.

Abstract BACKGROUND: Gestational trophoblastic neoplasia is one of a group of conditions resulting from abnormal trophoblast proliferation with capacity for invasion and metastasis. CLINICAL CASE: 42-year-old asymptomatic patient with ultrasound suspicion of hydatidiform mole. Uterine curettage and anatomopathological study confirmed the diagnosis of complete hydatidiform mole. With the consecutive quantification of three elevations of β-HCG a diagnosis of gestational trophoblastic neoplasia was made. It was staged as stage I, low-risk, and the patient agreed to hysterectomy plus bilateral salpingectomy. At subsequent follow-up the patient was found to be asymptomatic, with negative serial determinations of β-HCG and vaginal ultrasound scans without findings. CONCLUSION: Hysterectomy with bilateral salpingectomy may be the definitive treatment in selected cases of trophoblastic neoplasia. The available evidence is scarce and further research is needed in this field.

Association between antioxidant vitamins and oxidative stress among patients with a complete hydatidiform mole

OBJECTIVES: This study aimed to evaluate the potential relationship between oxidative stress, dietary intake, and serum levels of antioxidants in patients with a complete hydatidiform mole (CHM) compared with controls. METHODS: This was an observational cross-sectional study conducted in Rio de Janeiro, Brazil. A total of 140 women were enrolled in this study and divided into four groups: 43 patients with CHM, 33 women who had had an abortion, 32 healthy pregnant women, and 32 healthy non-pregnant women. All participants underwent blood sampling, assessment using a semiquantitative food frequency questionnaire, and anthropometric measurement. Blood samples were collected after overnight fasting (10-12 h). Vitamin levels (A, C, and E) were determined by ultra-performance liquid chromatography, and gamma-glutamyl transferase levels were assessed using an automated quantitative analysis system (Dimension®, Siemens). RESULTS: Although all groups showed sufficient serum vitamin A and E levels, the participants had inadequate dietary intake of these vitamins. Conversely, all groups had an insufficient serum level of vitamin C, despite adequate intake. The gamma-glutamyl transferase values did not differ significantly among the groups. However, elevated serum levels of this enzyme were observed in several patients. CONCLUSIONS: All groups exhibited high levels of oxidative stress, as evaluated by gamma-glutamyl transferase levels, and had inadequate intake of antioxidant vitamins. Therefore, the high exposure to oxidative stress found in our study, even in healthy pregnant and non-pregnant women, may increase the incidence of CHM in this region.

Differential expression of cyclin E, p63, and Ki-67 in gestational trophoblastic disease and its role in diagnosis and management: A prospective case–control study

Background: Gestational trophoblastic disease (GTD) constitutes a spectrum of tumors and tumor-like conditions, characterized by proliferation of pregnancy-associated trophoblastic tissue of progressive malignant potential. It is very difficult to differentiate these complex groups of lesions basing on histomorphology alone. Immunohistochemistry (IHC) with cyclin E, P63, and Ki-67 has a definite role in the identification of different trophoblasts and entities of GTD and also in the determination of biological behavior. Aims: The aim of this study is to find the differential expression of cyclin E, p63, and Ki-67 in normal placenta, hydropic abortus (HA), and various entities of GTD. Design and Settings: A prospective case–control study conducted in a government medical college. Methods: Total 96 cases, divided into Group A (48 histologically confirmed cases of GTD) and Group B (controls comprising 8 HA and 40 normal placentas of different trimesters), were studied. The histological samples were subjected to IHC using cyclin E, Ki-67, and p63. Statistical Analysis: Results were analyzed using SPSS statistical method. Results: Among the three immunomarkers used, Cyclin E and Ki-67 show statistically significant difference (P < 0.05) when compared between GTD and control groups, but it was insignificant for p63 (P = 0.369). Strong staining intensity of cyclin E and Ki-67 is seen in complete moles, choriocarcinoma, and placental site trophoblastic tumor. Conclusion: This study was done to evaluate the role of cell cycle regulatory proteins such as cyclin E and p63 and proliferation marker Ki-67 in the detection of various trophoblasts and differential diagnosis of the lesions associated with them.

Inter-observer variability in the histologic criteria of diagnosis of hydatidiform moles

@#Introduction: In the event of encountering hydropic villi in products of conception specimens, pathologists will have to distinguish complete and partial hydatidiform mole (CHM & PHM) from hydropic abortion (HA). The histological diagnostic criteria are subjective and demonstrate considerable inter-observer variability. Materials and Methods: This study evaluated the inter-observer variability in diagnosis of CHM, PHM and HA according to defined histologic criteria. Ninety abortus conception specimens were reviewed. Representative haematoxylin and eosin-stained slides were assigned independently to two pathologists who were asked to make a diagnosis of CHM, PHM or HA, and provide a report of the identified diagnostic histological criteria. Kappa value was calculated for the inter-observer agreement. Results: There was a total of 36.7% disagreement between two pathologists (K = 0.403, Strength of Agreement = moderate), of which 24.4% and 12.2%, were differentiating PHM from CHM and PHM from HA, respectively. Among defined diagnostic histological criteria, the highest rate of agreement was observed in the identification of cistern formation and hydropic changes (K = 0.746 and 0.686 respectively, Strength of Agreement = substantial). Conclusion: There was moderate to substantial agreement rate between two pathologists in identification of two essential histologic criteria for diagnosis of molar pregnancies i.e. “hydropic change” and “trophoblastic proliferation”.

The significance of the expression of p57, CD34 and Ki-67 in edematous lesions of placental villi / 新乡医学院学报

Objective To observe the expression of p57,CD34 and Ki-67 in complete hydatidiform mole (CHM),partial hydatidiform mole (PHM) and hydropic abortus (HA),so as to investigate the role of the expression in the diagnosis and differential diagnosis of edematous lesions of placental villi.Methods A total of 45 cases of CHM tissue,40 cases of PHM tissue,28 cases of HA tissue and 22 cases of normal pregnancy tissue were collected from January 2003 to December 2013 in Anqiu People's Hospital.The expression of p57,CD34 and Ki-67 in placental villi were detected by immunohistochemistry.Results The positive expression rate of p57 in CHM,PHM,HA and normal pregnancy tissues was 2.22％ (3/45),85.00％ (34/40),89.29％ (25/28) and 95.45 ％ (21/22),respectively;the positive expression rate of p57 in CHM tissues was significantly lower than that in PHM,HA and normal pregnancy tissues (x2 =59.908,57.055,58.238;P ＜ 0.01);there was no significant difference in the positive expression rate of p57 in PHM,HA and normal pregnancy tissues (x2 =0.022,0.681,0.074;P ＞0.05).The expression of CD34 in CHM,PHM,HA and normal pregnancy tissues was 10.27 ± 3.00,11.13 ±2.58,35.57 ± 2.36 and 35.55 ± 2.22 respectively;the expression of CD34 in CHM and PHM tissues was significantly lower than that in HA and normal pregnancy tissues (t =37.89,37.86,39.79,37.40;P ＜ 0.01).There was no significant difference in the expression of CD34 between HA and normal pregnancy tissues (t =1.485,P ＞ 0.05),and there was no significant difference in the expression of CD34 between CHM and PHM tissues (t =1.404,P ＞ 0.05).The positive expression rate of Ki-67 in CHM,PHM,HA and normal pregnancy tissues was 64.44％ (29/45),55.00％ (22/40),14.29％ (4/28) and 9.09％ (2/22) respectively;the positive expression rate of Ki-67 in CHM and PHM tissues was significantly higher than that in HA and normal pregnancy tissues (x2 =18.21,12.61,17.53,11.56;P ＜ 0.01);there was no significant difference in the positive expression rate of Ki-67 between HA and normal pregnant tissues (x2 =0.015,P ＞ 0.05),and there was no significant difference in the positive expression rate of Ki-67 between CHM and PHM tissues (x2 =0.787,P ＞ 0.05).Conclusion p57 helps to identify CHM and other edematous lesions of placental villi,CD34 and Ki-67 help to identify hydatidiform mole and HA.Combined detection of p57,CD34 and Ki-67 is helpful for differential diagnosis of CHM,PHM and HA.

Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study

OBJECTIVES: Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia. However, there is limited information on whether uterine artery Doppler flow velocimetry parameters can predict gestational trophoblastic neoplasia following a complete hydatidiform mole. The purpose of this study was as follows: 1) to compare uterine blood flow before and after complete mole evacuation between women who developed postmolar gestational trophoblastic neoplasia and those who achieved spontaneous remission, 2) to assess the usefulness of uterine Doppler parameters as predictors of postmolar gestational trophoblastic neoplasia and to determine the best parameters and cutoff values for predicting postmolar gestational trophoblastic neoplasia. METHODS: This prospective cohort study included 246 patients with a complete mole who were treated at three different trophoblastic diseases centers between 2013 and 2014. The pulsatility index, resistivity index, and systolic/diastolic ratio were measured by Doppler flow velocimetry before and 4-6 weeks after molar evacuation. Statistical analysis was performed using Wilcoxon’s test, logistic regression, and ROC analysis. RESULTS: No differences in pre- and post-evacuation Doppler measurements were observed in patients who developed postmolar gestational trophoblastic neoplasia. In those with spontaneous remission, the pulsatility index and systolic/diastolic ratio were increased after evacuation. The pre- and post-evacuation pulsatility indices were significantly lower in patients with gestational trophoblastic neoplasia (odds ratio of 13.9-30.5). A pre-evacuation pulsatility index ≤1.38 (77% sensitivity and 82% specificity) and post-evacuation pulsatility index ≤1.77 (79% sensitivity and 86% specificity) were significantly predictive of gestational trophoblastic neoplasia. CONCLUSIONS: Uterine Doppler flow velocimetry measurements, particularly pre- and post-molar evacuation pulsatility indices, can be useful for predicting postmolar gestational trophoblastic neoplasia.

Mola hidatidiforme completa con preeclampsia e hipertiroidismo: presentación clásica / Complete hydatidiform mole with preeclampsia and hyperthyroidism: classic presentation

Introducción: La enfermedad trofoblástica gestacional es un espectro de enfermedades de la placenta, existiendo entre ellas algunas con potencial de invasión y metástasis, dentro de las cuales se incluye la mola invasiva, coriocarcinoma, tumores del sitio de inserción de la placenta y mola hidatidiforme. Esta última a su vez se divide en mola completa y parcial, diferenciándose en histopatología, morfología, cariotipo, malignización y comportamiento clínico, que es el punto al cual nos referiremos en este caso. Caso clínico: mujer de 46 años ingresa por hemoptisis, metrorragia, disnea a pequeños esfuerzos, ortopnea y disnea paroxística nocturna, asociado a hipertensión, taquicardia, masa hipogástrica firme e inmóvil y edema de extremidades. Se realiza ecografía abdominal compatible con MH y bhCG elevada. Evoluciona con crisis hipertensivas, insuficiencia cardiaca congestiva y tirotoxicosis. Inicia trabajo de parto expulsando 665 grs de mola, presentando posteriormente a legrado uterino anemia severa y shock hipovolémico, requiriendo transfusiones y drogas vasoactivas. Se recupera progresivamente con posterior control al alta de bhCG indetectable a los 6 meses. Discusión: Es infrecuenta en la actualidad la presentación clínica clásica de la mola hidatidiforme completa debido al diagnóstico y control precoz del embarazo asociado al uso masivo de la ecografía. Sin embargo es relevante tener un alto grado de sospecha de esta patología debido a sus graves consecuencias, y así realizar una derivación y manejo precoz.

Background: Gestational trophoblastic disease is a spectrum of diseases of the placenta, existing some with potential for invasion and metastasis, among which include invasive mole, choriocarcinoma, tumors of the insertion site of the placenta and hydatidiform mole. The last one is divided into complete and partial mole, differing in histopathology, morphology, karyotype, and clinical malignant behavior, witch is the point we refer to in this case. Case report: 46 year old woman admitted for hemoptysis, metrorrhagia, dyspnea on slight exertion, orthopnea and paroxysmal nocturnal dyspnea associated with hypertension, tachycardia, firm and immovable hypogastric mass and limb edema. Abdominal ultrasound compatible with MH and high BhCG is performed. Evolve with hypertensive crisis, congestive heart failure and thyrotoxicosis. Labor starts driving out 665 grams of mole, after the curettage present hypovolemic shock and severe anemia requiring transfusions and vasoactive drugs. It gradually recovers further control the discharge of BhCG undetectable at 6 months. Discussion: It is currently infrequent classical clinical presentation of complete hydatidiform mole due to early diagnosis and management of pregnancy associated with the widespread use of ultrasound. However it is important to have a high degree of suspicion of this disease because of its serious consequences, and thus make a referral and early management.

Mola hidatiforme coexistente con feto vivo después de las 20 semanas de gestación: reporte de dos casos / Hydatidiform mole coexisting with a live fetus greater than 20 weeks of gestation: Two cases report

Resumen Antecedentes: el embarazo molar coexistente con un feto vivo es una rareza y un reto médico porque se asocia con complicaciones maternas graves que ponen en riesgo la vida de la madre y su hijo. Casos clínicos: Caso 1: paciente con embarazo gemelar, con mola completa coexistente con feto vivo y terminación del embarazo por cesárea a las 33 semanas, nació una niña viva, de 1530 g, que sobrevivió sin complicaciones. Caso 2: paciente con mola parcial, embarazo complicado con preeclampsia severa, hipertiroidismo y placenta previa. La gestación se interrumpió por cesárea a las 24 semanas, el feto pesó 625 g y no sobrevivió a las maniobras de reanimación neonatal. Conclusiones: en las pacientes con embarazo molar coexistente con feto vivo deben valorarse las complicaciones presentes o potenciales que condicionan el riesgo de muerte materna y perinatal. La atención médica debe ser multidisciplinaria y siempre de común acuerdo con los padres.

Abstract Background: Coexistance of molar pregnancy and alive fetus is an extremely rare condition but a medical challenge when it is present. Several maternal medical complications are associated with these pregnancies including both mother and fetus life-threatening conditions. Clinical case: Two cases of molar pregnancies are presented in this paper. First was a twin pregnancy with a complete hydatidiform coexisting with a live fetus and cesarean birth at 33 weeks of gestation of a live female weighing 1,530 g. that survived without complications. Second case was an incomplete mole complicated with severe pre-eclampsia, hypertiroidism, and placenta previa; pregnancy was interrupted at 24 weeks of gestation and a fetus weighing 625 g was extracted by cesarean section, the neonate did not survive. Conclusion: In the presence of molar pregnancy coexisting with a live viable fetus, the present or potential complications that determine the risk of maternal and perinatal death, must be carefully assessed. A third-level perinatal facilities must be available for this kind of pregnancy complication.

Morphological Features and Immunohistochemical Expression of p57Kip2 in Early Molar Pregnancies and Their Relations to the Progression to Persistent Trophoblastic Disease

BACKGROUND: Although the morphological features characteristic of products of conception specimens including molar pregnancies are well described, substantial histopathological similarities are observed between the different entities, especially in cases of early pregnancies. Furthermore, there are no current solid criteria that could predict cases with progression to persistent gestational trophoblastic disease. In this study, we aimed to determine the most specific histopathological and immunohistochemical features required for accurate diagnosis that can reliably predict the clinical behavior. METHODS: Sixty-five cases of products of conception were reviewed clinically and pathologically, and any progression to persistent gestational trophoblastic disease (GTD), if present, was noted. Pathological assessment of the archival material included re-cut sections of 5 μm in thickness, routine staining with hematoxylin and eosin and immunohistochemical staining of p57Kip2. RESULTS: Certain histopathological criteria were found to be significant in differentiation between complete hydatidiform mole (CHM) and partial hydatidiform mole including villous shape and outline, villous trophoblast hyperplasia, and atypia in extravillous trophoblasts. There were no significant differences in any morphological or immunohistochemical features between cases with or without subsequent development of GTD. CONCLUSIONS: Histopathological diagnosis of molar pregnancy remains problematic especially in early gestation. Their diagnosis should be stated after a constellation of specific histopathological criteria in order not to miss CHM. p57Kip2 immunohistochemistry is of great value in diagnosis of cases that had equivocal morphology by histopathological examination. However, there were no significant features to predict cases that subsequently developed persistent GTD.

Mola hidatiforme completa y feto vivo a término coexistente: reporte de caso / Complete hydatidiform mole and alive fetus to term coexistent. case report

Se presenta el caso de una mola hidatiforme completa y feto vivo a término coexistente en una paciente de 30 años, II gestas I para, con embarazo de 29 semanas y elevación de la presión arterial. La imagen ecográfica al ingreso de la placenta sugirió la presencia de mola hidatiforme junto a un feto normal. Se realizó seguimiento expectante hasta las 37 semanas, cuando presentó un episodio de sangrado genital por lo que se realizó una cesárea y se obtuvo un recién nacido vivo masculino normal, placenta y una tumoración de un tejido vesicular. El examen de anatomía patológica del tejido vesicular reportó mola hidatiforme completa.

A case of complete hydatiform mole with live term coexisting fetus in a 30-year-old patient, II gravida, 1 para, with a pregnancy of 29 weeks and rise of blood pressure is presented. Ultrasound image at admission suggested the presence of hydatiform mole together a live fetus. Patient was followed until 37 weeks, when presented an episode of vaginal bleeding cause a cesarean section was done and a live normal male newborn, placenta and a vesicular tissue tumor were obtained. Pathology exam of vesicular tissue reported complete hydatiform mole.

Gestação gemelar de mola hidatiforme completa com feto vivo / Twin pregnancy with complete hydatidiform mole and living fetus

A gestação gemelar de uma mola hidatiforme completa coexistindo com um feto vivo é uma entidade rara. Os poucos casos descritos na literatura mostram que, em geral, esse tipo de gestação cursa com risco aumentado de aborto espontâneo, parto prematuro, morte fetal intraútero, sangramento, pré-eclâmpsia e doença trofoblástica persistente. Neste artigo, descreveremos o caso de uma primigesta de 20 anos de idade que apresentou uma gestação gemelar de feto vivo com mola completa, a qual transcorreu sem intercorrências e complicações e cujo diagnóstico diferencial com degeneração da placenta foi feito com anatomopatológico.

Twin pregnancy with a complete hydatidiform mole and a living fetus is a rare entity. According to the few cases described in the literature, this kind of gestation commonly has higher risks of miscarriage, preterm delivery, intrauterine fetal death, bleeding, preeclampsia and persistent trophoblastic disease. This study reports the case of a 20 years old primiparous patient with complete hydatidiform mole and living fetus, whose pregnancy was successfully carried to term. The differential diagnosis with placental degeneration was reached through anatomopathological investigation.

A Case of the Complete Hydatidiform Mole with Two Coexisting Fetuses / 대한주산의학회잡지

Hydatidiform mole with a coexisting fetus is rare, but this condition has recently shown an increased incidence because of assisted reproduction technology. In most of the reported cases, termination at diagnosis was preferred due to poor fetal survival and maternal risk factors such as vaginal bleeding, preeclampsia, hyperthyroidism, potential of malignant change. However, considering the value of pregnancy by assisted reproduction technology, whether to continue or to terminate this condition is a dilemma. Based on currently available information, it seems that it is reasonable to allow the pregnancy to continue in the absence of maternal complications. We report on a case of the complete hydatidiform mole with two coexisting fetuses with a brief reviews of the literature.

RELACIÓN DE LA EXPRESIÓN DE mARN DE LAS METALOPROTEINASAS 2 Y 9 Y EL INHIBIDOR TIMP-1 EN MOLA HIDATIDIFORME COMPLETA / RELATIONSHIP BETWEEN METALLOPROTEINASES 2 AND 9 AND TIMP-1 INHIBITOR mRNA EXPRESSION IN HYDATIDIFORME MOLE / RELAÇÃO DA EXPRESSÃO DE mRNA DAS METALOPROTEINASAS 2 E 9 E DO INHIBIDOR TIMP-1 NA MOLA HIDATIDIFORME COMPLETA

Durante el comienzo de la gestación el factor de crecimiento similar a la insulina tipo II (IGF-II) se expresa abundantemente en la placenta y podría regular el comportamiento invasivo de las células trofoblásticas. La habilidad invasiva dependerá también de la capacidad de secretar metaloproteinasas (MMPs), cuya expresión anormal contribuye a varios procesos patológicos. En la Enfermedad Trofoblástica Gestacional (ETG) estos factores podrían estar desregulados, así la mola hidatidiforme completa (MHC) conduce a la formación del coriocarcinoma, que es un tumor invasivo y metastásico. El objetivo de este estudio fue investigar la relación entre los niveles de mARN de IGF-II, MMP-2, MMP-9 y TIMP-1, por la técnica de RT-PCR, en tejidos de mola hidatidiforme vs. placentas de primer trimestre. La actividad de las MMPs se evaluó usando el ensayo de zimografía, encontrando que en MHC ésta se incrementa, lo cual podría relacionar la malignización del trofoblasto con el incremento en su capacidad invasiva. La expresión elevada de IGF-II en esta patología, también podría estar asociada con el incremento en la actividad de estas MMPs. Una mayor relación entre la expresión de mARNde MMP-9/TIMP-1 en la mola hidatidiforme completa se sugiere como predictor de malignización del tejido trofoblástico .

At the beginning of gestation the Insulin Like Growth Factor II (IGF-II) is highly expressed in placenta and it could regulate the invasive behavior of trophoblastic cells. This invasive ability depends on its capability to secret metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs), abnormal expression of which could contribute to several pathological processes.In the Gestational Trophoblastic Diseases (GTD) these factors could be unregulated, in this way complete hydatidiforme mole (CHM) produces the choriocarcinoma which is an invasive and metastasic tumor. The aim of this study was to investigate the relationship between IGF-II, MMP-2, MMP-9 and TIMP-1 mRNA levels by RT-PCR technique, in hydatidiform mole tissues vs. first normal trimester placentas. MMPs activity was evaluated using zimography assay finding that in CHM this is increased, which could relate trophoblast malignization with an increased invasive capability. The higher IGF-II mRNA expression in this pathology could, also, be associated with increased MMPs activity. A higher MMP-9/ TIMP-1 mRNA expression ratio in CHM is suggested as a predictor of trophoblastic tissue malignization .

No início da gestação o fator de crescimento semelhante à insulina tipo II (IGF-II) é altamente expresso na placenta e poderia regular o comportamento invasivo das células trofoblásticas. Esta habilidade invasiva também depende da sua capacidade de produzir metaloproteinasas (MMP) e inibidores das mesmas (TIMP), expressão anormal da qual poderia contribuir em vários processos patológicos. Nas Doenças Trofoblásticas da Gestação (Gestational Trophoblastic Disease, ETG) estes fatores poderiam ser desregulados; deste modo a Mola Hidatidiforme Completa (MHC) produz coriocarcinoma que é um tumor invasivo e metastásico. O objetivo deste estudo era pesquisar a relação entre os níveis de mRNA do IGF-II, MMP-2, MMP-9 e TIMP-1, através da técnica de RT-PCR em tecidoos da MHC vs. placenta do primeiro semestre. Atividade das MMP foram avaliadas pelo ensaio de zimografia achando que em MHC aumenta; isto poderia relacionar o incremento do malignidade do trofoblasto com uma capacidade invasiva aumentada. A expressão mais alta do IGF-II nesta patologia pode também estar associada com atividade aumentada destas MMP. Uma relação aumentada da expressão do mRNA de MMP-9/TIMP-1 na MHC é sugerida como um preditor do incremento da malignidade do tecido trofoblástico .

Complete Hydatidiform Mole with a Coexisting Fetus: A case report

Twin conceptus of a complete hydatidiform mole (CHM) and a normal fetus are rare but are important because of diagnostic difficulty, problems related to twin pregnancy, and high risk of persistent gestational trophoblastic tumor. Recently, we experienced one case of twin pregnancy consisting of a CHM and a normal fetus. A 26-year-old woman complained of vaginal bleeding. She had evidences of pregnancy-induced hypertension. A male fetus was delivered at 20 gestational weeks. The placenta demonstrated vesicles of molar change separated from normal placenta. Microscopically, the molar villi disclosed diffuse hydropic swelling with circumferential trophoblastic proliferation. DNA flow cytometric analysis showed diploid patterns in both molar and normal placental tissues. Fluorescent in situ hybridization in paraffin-embedded tissue presented that normal placental villi hybridized with X- and Y-chromosome probes (46, XY), while molar villi hybridized with X-chromosome only (46, XX). Thus, dizygotic twinning was confirmed because sex differences were shown between molar villi and normal placental villi. Follow up beta-hCG was within normal range after delivery.

A Case of Complete Hydatidiform Mole in a triplet pregnancy following In Vitro Fertilization and Embryo Transfer / 대한산부인과학회잡지

A complete hydatidiform mole coexisting with a fetus is a rare condition, particularly when diagnosed after IVF-ET. In spite of the wide spread use of assisted reproductive technology, there have been, to our knowledge, only few reported cases of molar pregnancy after IVF-ET. At present, there are limited data to guide the antenatal management of a complete hydatidiform mole coexisting with fetuses. A complete mole can coexist with a normal, healthy fetus who can be carried to term, with good outcome. But, patients who desire to continue the pregnancy after such a diagnosis must be cautioned about the potential for severe medical complications and developing persistent gestational trophoblastic tumor. We report here a case of complete hydatidiform mole in a triplet pregnancy coexistent with two live fetuses following in IVF-ET.

Telomerase Activity in Gestational Trophoblastic Disease / 대한산부인과학회잡지

The purpose of this study was to evaluate the significance of telomerase activity in gestational trophoblastic disease and the association of telomerase activity in complete hydatidiform mole and subsequent development of persistent gestational trophoblastic tumor. By using the standard telomerase repeat assay, we examined telomerase activity in 2 normal placentas, 31 complete hydatidiform moles, 7 invasive moles, 5 choriocarcinoma tissues and choriocarcinoma cell line (JEG-3). Telomerase activity was detected in 13 of 15 (86.7%) complete hydatidiform mole patients who eventually had chemotherapy for the treatment of persistent gestational trophoblastic tumor. All of the 9 patients with metastatic disease (FIGO Stage III) had telomerase activity in their initial molar tissue. In contrast, telomerase activity was evident in only two of 16 (12.5%) complete hydatidiform mole patients with spontaneous remission. While telomerase activity was not detected in normal placentas, high level of telomerase activity was detected in all of 7 invasive moles, 5 choriocarcinoma tissues and choriocarcinoma cell line (JEG-3). The presence of telomerase activity in a complete hydatidiform mole is associated with the development of persistent gestational trophoblastic tumor, such as invasive mole and choriocarcinoma.

A Case of Complete Hydatidiform Mole with Coexistent Live Fetus / 대한산부인과학회잡지

Hydatidiform moles are generally separated into two clasifications. Complete hydatidiform moles are characterized by cystic swlling of all villi, often pronounced trophoblastic hyperplasia, lack of fetal parts, all 46 chromosomes of paternal origin(androgenesis), and a major risk for persistent trophoblastic tumor. Partial hydatidiform moles appear to be a milder version of complete moles with both normal and cystic villi, focal trophoblastic hyperplasia, a fetus or indications of previous fetal existence, 69 chromosomes with a maternal contribution, and a malignant potential less than described for complete moles. Hydatidiform mole with coexistent fetus is a very rare phenomenon, with an estimated incidence of 0.005 to 0.01 percent of all pregnancies. The rarity of live-born, surviving children may in part be due to termination of pregnancies, when molar parts are observed and without access to current advanced diagnostic procedures. Progress in techniques for first trimester prenatal diagnosis and improved surveillance of first trimester pregnancies through prenatal chromosomal analysis, ultrasound scan, maternal serum-hCG and serum- AFP screening has created complex situation, allowing confirmation of hydatidiform mole with coexisitng fetus. We recently experienced one case of unusual pregnancy with complete hydatidiform mole and coexisiting live fetus.

Comparative Cytogenetic and Clinicopathologic Studies on Gestational Trophoblastic Neoplasia, especially Hydatidiform Mole

Hydatidiform mole has been known for its potential for malignant transformation and for its various chromosomal karyotypes. However, the relationship between histologic grading of hydatidiform mole and its future malignant transformation is still controversial. This study was undertaken to determine the cytogentic aspects of gestational trophoblastic neoplasia, especially of hydatidiform mole with respect to its malignant transformation. Cytogenetic studies were performed in 34 cases of hydatidiform mole, 2 cases of invasive mole, and 2 cases of choriocarcinoma. The results were analyzed comparatively using clinical histopathological and endocrinological (human chorionic gonadotropin titer) data. Among the 34 cases of hydatidiform mole studied, 26 cases were complete moles and the remaining 8 were partial moles with karyotypes being diploid (46, XX, 24, 46, XY, 2), and triploid (69, XXY) respectively. Two cases of XX mole among 26 complete hydatidiform moles developed distant metastasis during the follow-ups, suggesting transformation into choriocarcinoma; both cases showed 46, XX in karyotype and Grade III in histologic grading. Not one case of triploid partial hydatidiform mole transformed into malignancy. The karyotypes of the two cases each of invasive mole and choriocarcinoma were from neardiploid to hypotetraploid, and aneuploid cells were predominant in choriocarcinoma.