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.

Atualização no diagnóstico e tratamento da gravidez molar / Update on the diagnosis and treatment of molar pregnancy

A doença trofoblástica gestacional (DTG) é um termo aplicado a um grupo de tumores relacionados à gestação, caracterizado por entidades clínicas benignas (mola hidatiforme ? MH) e malignas (neoplasia trofoblástica gestacional ? NTG). Os principais desafios para o tratamento das pacientes com MH abrangem o diagnóstico precoce, esvaziamento uterino imediato e seguimento pós-molar regular com dosagem sérica de hCG, melhorando assim o prognóstico das pacientes, sua qualidade de vida e resultados reprodutivos. A atualização das estratégias diagnósticas e terapêuticas envolvidas no tratamento da DTG, foco deste trabalho, tem por objetivo melhorar esse cenário, contribuindo para o maior conhecimento sobre o assunto.

The gestational trophoblastic disease (GTD) is a term applied to a group of pregnancy related tumors, characterized by benign clinical entities (hydatidiform mole ? HM) and malignant ones (gestational trophoblastic neoplasia ? GTN). The main challenges for treatment of patients with HM include early diagnosis, immediate uterine evacuation and systematic post-molar follow-up with seric dosage of hCG, improving the prognosis of patients, their quality of life and reproductive outcomes. The focus of the present paper is the update of diagnostic and therapeutic strategies involved in the treatment of GTD aiming to improve this scenario to enhance the knowledge on the subject.

Recurrent hydatidiform mole: a case report of six consecutive molar pregnancies complicated by choriocarcinoma, and review of the literature

Hydatidiform mole [HM] is the most common form of gestational trophoblastic neoplasia. Recurrence of HM is extremely rare. Here, we report the case of a patient with six consecutive partial HMs without normal pregnancy. A 42-year-old lady who was referred to us at King Fahad Hospital of the University, Al Khobar, initially as a case of 26-year-old with persistent trophoblastic disease after three recurrent molar pregnancies that were confirmed histologically in the referring hospital. She underwent evacuation and curettage and was followed up by serial beta -human chorionic gonadotropin levels, and did not require chemotherapy. She then had three more molar pregnancies in 1995, 1996, and 2004; all molar pregnancies were evacuated by suction curettage at her base hospital, but in the last event, she complained of shortness of breath and abdominal pain. Diagnostic workup in our hospital confirmed choriocarcinoma, for which she received multiple regimen chemotherapy and was cured. Unfortunately, she lately presented with symptoms suggestive of premature menopause

Mola hidatidiforme parcial con feto vivo del segundo trimestre / Partial hydatiform mole with live fetus in the second trimester

La mola hidatidiforme es un embarazo que se caracteriza por una degeneración hidrópica de las vellosidades coriales y habitualmente la ausencia del feto. La mola parcial se caracteriza por ser resultado de una triploidía diádrica y por la presencia de cambios hidatiformes progresivos lentos con capilares vellosos funcionantes, que afectan solamente a algunas de las vellosidades; se asocia con un feto o embrión anormal identifcable (vivo o muerto), membranas o eritrocitos fetales. Se analiza un caso de mola parcial con feto de 18 semanas.

Hydatidiform mole is a pregnancy that is characterized by hydropic degeneration of placental villi and usually the absence of fetus. The partial mole is characterized as a result of triploidy diandrica and the presence of slow progressive changes with hydatidiform villous capillaries functioning that affect only some of the villi, in addition to being associated with an identifable abnormal fetus or embryo (dead or alive), fetal membranes or erythrocytes. We analyze a case of partial hydatidiform mole with a fetus of 18 weeks.

Mola hidatiforme e doença trofoblástica gestacional: [revisão] / Hydatidiform mole and gestational trophoblastic disease: [revision]

A mola hidatiforme é uma complicação relativamente infrequente da gravidez, mas com potencial para evolução para formas que necessitam de tratamento sistêmico e podem ser ameaçadoras da vida. Sob a denominação de mola hidatiforme há duas entidades histopatológicas e clínicas: a mola parcial e a completa. As diferenças entre estas duas formas são importantes, devido ao risco de evolução para formas persistentes, ou seja, mais alto para as completas. O diagnóstico da mola hidatiforme, seu tratamento e seguimento após o tratamento inicial sofreram alterações importantes nos últimos anos. O número de pacientes assintomáticas tem aumentado devido ao emprego de ultrassonografia no início da gravidez. Para a resolução da mola hidatiforme é necessário evitar o emprego de medicamentos que induzam contrações uterinas e usar a vácuo-aspiração. Deve ser prescrito o método contraceptivo hormonal logo após o esvaziamento da mola. O seguimento é baseado nas dosagens seriadas semanais de gonadotrofinas coriônicas. É importante que o método empregado detecte todas as formas das gonadotrofinas coriônicas (molécula intacta, hiperglicosilada, subunidade β livre e fragmento central da subunidade β).

The hydatiform mole is a relatively rare pregnancy complication, but with potential to evolve to forms which need systemic treatment and can be a threat to life. There are two histopathological and clinical entities under the name of hydatiform mole: the partial and the complete mole. The differences between the two forms are important due to risk of evolution to persistent forms, which is higher for the complete moles. The diagnosis, treatment and follow-up of hydatiform mole have been under important changes in the last years. The number of asymptomatic patients has increased, due to the use of ultrasonography at the onset of pregnancy. The use of medication that induces uterine contractions must be avoided, and vacuum aspiration should be used. Soon after emptying the mole, a hormonal contraceptive method should be prescribed. Follow-up should be based on weekly serial dosages of chorionic gonadotropin. It is important that the method employed detects all the forms of chorionic gonadotropins (intact molecule, with hyper glycol, free β subunit, and central fragment β subunit).

Molar pregnancy - experience at a tertiary care hospital of South Punjab

To determine the frequency, clinical presentation and management outcomes of molar pregnancy. Descriptive cases series. Department of Obstetrics and Gynaecology Unit-II. Bahawal Victoria Hospital, Bahawalpur, from January 2005 to December 2007. The case records of all the gestational trophoblastic cases during the study period were analyzed regarding their history, clinical examination, investigations, treatment and follow up. The main outcomes were measured in terms of duration, antecedent pregnancy, investigations, treatment and follow up. There were a total of 21499 admissions during study period which included 54 cases of molar pregnancy. Hence frequency of Molar pregnancy was 2.5/1000 pregnancies. Most of the patients belonged to the extremes of ages. Most common presenting complaint was bleeding per vagina in 39[72.2%]. Out of 54 patients, suction evacuation was done in 51[94.4%] patients and in only 3[5.5%] patients, ended up in hysterectomy. Forty one [75.9%] patients received no adjuvant therapy, 13[24.1%] received chemotherapy. Among all 54 cases, 51[94.4%] patients fully recovered and 3[5.6%] died because of extensive disease and reported late. In this series, frequency of molar pregnancy was as equal as in different parts of the world. Proper management in the early stages influences the outcome of the disease. Hence the key point of whole discussion is to detect the disease in early stage to decrease the mortality and morbidity of patients

Neoplasia trofoblastica gestacional: Hospital Félix Bulnes Cerda, 1992 - 2002 / Gestational trophoblastic neoplasia: Hospital Félix Bulnes Cerda, 1992 - 2002

Objetivo: Analizar los hallazgos clínicos y el seguimiento de los casos de neoplasia trofoblástica gestacional. Material y Métodos: Se revisaron todos los casos de mola hidatidiforme en el Hospital Félix Bulnes Cerda, entre los años 1992 y 2002. Resultados: Se diagnosticaron 79 casos. La edad promedio de las pacientes fue 26,4 años. El diagnóstico de mola hidatidiforme fue sospechado clínicamente en 75,6 por ciento y en 24,4 por ciento fue hallazgo anatomopatológico. Los principales síntomas al ingreso fueron: dolor hipogástrico (75,6 por ciento), náuseas y/o vómitos (32,1 por ciento) y disuria (19,2 por ciento). Entre los signos clínicos destacan sangrado vaginal (83,3 por ciento), altura uterina discordante (25,3 por ciento) y expulsión de vesículas (12,8 por ciento). La ecografía concluyó mola hidatidiforme en 74,4 por ciento y quistes tecaluteínicos en 23,1 por ciento. Los hallazgos de anatomía patológica fueron mola completa (61,5 por ciento), mola parcial (31,2 por ciento) y coriocarcinoma (1,3 por ciento). En el seguimiento, 30,8 por ciento no volvieron a control y 23,1 por ciento tuvieron entre 7 y 12 controles. Conclusión: Los hallazgos de este estudio son similares a los descritos en la literatura.

Conduta na doença trofoblástica gestacional (DGT): experiência de 10 anos de um centro de referência no manejo de pacientes com mola hidatiforme de evoluçäo näo complicada / Management of Gestational Trophoblastic Disease-Hydatidiform mole with non complicated evolution: results of a 10 yearïs experiece in a reference center

Ensaio clínico sistematizado e prospectivo, envolvendo 285 pacientes com MH que tiveram evolução não complicada e que foram manejadas no Centro de Doenças Trofoblásticas da ISCMPA-RS, num período de 10 anos, pela mesma equipe personalizada e multiprofissional...

A case of membranoproliferative glomerulonephritis associated with a hydatidiform mole

We treated a 54-year-old woman who was suffering from membranoproliferative glomerulonephritis associated with a complete type of hydatidiform mole. The renal manifestations were proteinuria and hematuria. A renal biopsy, performed before gynecologic management, disclosed focal and segmental subendothelial deposits with a proliferation of the mesangial cell and showed irregularly thickened capillary loops by light and electronmicroscoy. Genralized edema, proteinuria and hematuria were completely recovered by suction and curettage of the hydatidiform mole with prophylactic chemotherapy. The clinical manifestation of earlier presented 3 cases have been the nephrotic syndrome. The common feature of them was a complete remission of the nephropathy after the removal of the hydatidiform mole. The relationship between the hydatidiform mole and glomerulonephritis remains unresolved at present. But we concluded that the hydatidiform mole might be a cause of glomerulonephritis in this case.

Manejo de la enfermedad del trofoblasto: mola parcial y completa / Management of trophoblastic disease: partial and complete mole

Se comunican 67 pacientes con enfermedad del trofoblasto tratadas entre 1982 y 1998. Se incluyen 44 molas completas y 23 molas parciales. Un resultado relevante fue el diagnóstico de enfermedad del trofoblasto por hallazgo en el estudio anátomo-patológico sin la sospecha clínica en un 25,54 por ciento de los casos (mola completa 20,5 por ciento, mola parcial 34,8 por ciento). No hubo diferencias significativas en la clínica entre mola parcial y completa. La persistencia de enfermedad fue mayor en el grupo con mola completa. La respuesta al tratamiento primario con quimioterapia en enfermedad persistente usando monodroga fue 75 por ciento. Respecto de la fertilidad futura, 30 pacientes se embarazaron con un total de 45 embarazos con una tasa de aborto de 6,7 por ciento y de recurrencia para enfermedad molar de 2,2 por ciento

Mola hiditiforme casuística en la Maternidad Isidro Ayora (1993-1997) / hiditiforme Mola casuistry in the Maternity Isidro Ayora (1993-1997)

Hemos analizado 149 casos diagnosticados de mola hidatiforme en el Hospital gineco-obstétrico Isidro Ayora, fueron estudiados retrospectivamente. Durante el mismo período hubo 55.738 partos. La incidencia fue de un caso por cada 374 partos y 366 nacidos vivos, y una tasa de 2,67 por 1000 partos. De estos casos el 84.3 por ciento eran benignos y el 15.6 por ciento potencialmente malignos, luego de la investigación histopatológica. La mayor parte de pacientes estaban entre 14 y 20 años (28.1 por ciento). Mas de la mitad de las pacientes eran multigestas. El sangrado fue el signo más frecuente (81.2 por ciento). El 5.3 por ciento de los casos presentaron molas recurrentes. El tratamiento de elección en la mayoría de casos fue un legrado instrumental más un curetaje por succión...

Complete hydatidiform mole five years review in Mosul

[a]: To describe the age and parity characteristic of women with complete hydatidiform Mole [CHM] in Mosul. [b]: To estimate the relative frequency of CHM in relation to pregnancy. [C]: To estimate the rate of recurrence and malignant changes in CHM. Design: Case-series study. Data from hospital patients with CHM are utilized. Setting: Al-Batool Maternity Hospital, during the period from 1979 to 1983. Participants: 130 women with CHM The total admission for deliveries and abortions during the same period in the same hospital was 62682 [abortion 18960 and deliveries 43722]. Intervention: Diagnosis of CHM was based on clinical criteria, HCG pregnancy test and ultrasound. Main Outcome Measures: Age, parity, mode of presentaion, laboratory investigations and treatment given The relative frequency [incidence] and rates of recurrence and malignant changes were calculated The relative occurring frequency was 1/482 with the highest rate of CHM occured in 30-35 year aged group and among patients whose parity ranged between zero to three. The recurrence rate within the same patient was 1.7% and fifteen patients [11.5%] developed choriocarcinoma. The relative frequency of CHM in Mosul was high and comparable to reported frequency in other countries in the Middle East Malignant changes in those patients were also high and proper follow up is recommended

Coriocarcinoma de ovario: reporte de un caso

Se presenta el caso de una niña de 10 años, paciente del Hospital Provincial Cotopaxi, que ingresa con cuadro caracterizado por sangrado genital de 20 días de evolución, utero leñoso y doloroso, la pacientes había sido objeto de una violación, 5 meses antes de su ingreso. Luego de ecografía pélvica se determina diagnostico de mola hidatiforme, por lo que se intenta evacuarla por medio de una aspiración endouterina. Al no conseguir el vaciamiento completo del contenido uterino se laparotomiza a la paciente, encontrandose una masa tumoral dependiendo de ovario derecho, la misma que se extrae, Luego del análisis histopatológico se establece la existencia de un coriocarcinoma.

Enfermedad trofoblástica gestacional en el Hospital Nacional Cayetano Heredia. Aspectos epidemiológicos y clínicos / Gestational trophoblastic disease at the Hospital Cayetano Heredia. Epidemiological and clinical aspects

Con el objetivo de evaluar aspectos clínicos y epidemiológicos, se revisaron 113 historias clínicas de pacientes con Enfermedad Trofoblástica Gestacional (ETG) atendidas en el Departamento De Obstetricia y Ginecología del Hospital Nacional Cayetano Heredia entre Enero de 1981 y Diciembre de 1990se encontró una frecuencia de 2.33 casos de ETG por 1000 embarazos. La frecuencia fue significativamente mayor en las gestantes mayores de 40 años (22.09 por 1000 partos). La ginecorragia fue el signo de presentación más frecuente (90.26 por ciento), seguido por desproporción altura uterina-tiempo de amenorrea (39,82 por ciento) e hiperemesis gravídica (29.20 por ciento). El legrado uterino fue el único tratamiento empleado en el 76.80 por ciento de las pacientes. Se registraron tres casos de coriocarcinoma, en 17 pacientes se registró actividad trofoblástica persistente en el seguimiento post-evacuación, y en cinco se evidenciaros lesiones radiológicas compatibles con metástasis pulmonares. No se encontró asociación entre los factores pronósticos reconocidos en la literatura y la persistencia de actividad trofoblástica en estas pacientes.

Enfermedad trofoblástica gestacional: análisis de 15 casos servicio de gineco-obstetricia Hospital General Dr. Pastor Oropeza.I.V.S.S Barquisimeto 1983-1985 / Gestational trophoblastic disease: analysis of 15 cases gyneco-obstetric service General Hospital Dr. Pastor Oropeza I.V.S.S. Barquisimeto 1983-1985

Se observaron 15 casos de Enfermedad Trofoblástica Gestacional en el Servicio de Gineco-Obstetricia del Hospital General "Dr. Pastor Oropeza" de Barquisimeto, en el lapso comprendido entre 1983-1985. Se analizó incidencia, procedencia, relación con la edad gestacional, paridad, abortos, se correlacionó el diagnóstico clínico histológico y persistencia de enfermedad, se correlacionó los títulos iniciales de gonadotrofinas, fracción Beta, con el diagnóstico histológico. Se analizó la respuesta el tratamiento profiláctico y se analizó en forma general el patrón de seguimiento observado. Se recomienda un control cuidadoso en todos los casos con diagnóstico de Mola Hidatiforme, en una consulta especial, para su seguimiento y tratamiento adecuado

Atualizaçäo no atendimento da neoplasia trofoblástica gestacional / Updating in the care of gestacional trophoblastic neoplasm

Os autores descrevem a rotina adotada no Setor de Neoplasia Trofoblástica Gestacional da Maternidade-Escola Assis Chateaubriand, da Universidade Federal do Ceará, em Fortaleza, Ceará, Brasil. Na oportunidade salientam a necessidade da fixaçäo de uma conduta uniforme, que possibilite a orientaçäo de todos os casos e däo ênfase as normas para seguimento de cada paciente, com a internaçäo de uma equipe multiprofissional, posta a serviço do Setor competente

Benign hydatidiform mole in Benghazi, Libya

A statistical review of 65 cases of hydatidiform mole [HM] seen at Al Jamahiria Hospital, Benghazi, from January 1979 to December 1980 is presented. During that period there were 32722 Deliveries and 6217 abortions managed in the same hospital. The hospital incidence of HM was 1: 600 pregnancies and the condition was seen most commonly in young women and those near the end of their reproductive years. There was no correlation between HM and parity or previous abortions. Management of the condition generally was conservative because of the interest of our patients to have big families. Subsequent pregnancies in some patients followed within 6 months of treatment