Mola invasiva. presentación de un caso / Mola invasiva. Apresentação de um caso / Invasive mole. Case presentation

Se presentó un caso de enfermedad trofoblástica tipo mola invasiva. El diagnóstico se sospechó con la ecografía del primer marcador genético, se realizaron dos legrados terapéuticos, el segundo de ellos, sugirió el diagnóstico de mola invasiva. Se realizó tratamiento quirúrgico (histerectomía total) con previa administración de quimioterapia con metotrexato sistémico. La biopsia confirmó el diagnóstico de mola invasiva. La mola invasiva es una de las formas de presentación de la enfermedad trofoblástica gestacional, es una condición infrecuente, en que la proliferación de células del trofoblasto y sincitiotrofoblasto penetran o incluso perforan la pared uterina, producen destrucción local pudiendo invadir el tejido parametrial y los vasos sanguíneos viajando dentro de estos, aunque no se han reportado verdaderas siembras metastásicas en otros órganos. La evolución clínica se realizó en consulta externa. Transcurrido dos años la evolución es satisfactoria, el tratamiento efectivo y bien tolerado por la paciente(AU).

A case of trophoblastic disease, of the invasive mole type was presented. The diagnosis was first suspected with the ultrasound of the first genetic marker. Two therapeutic curettages were performed, the second of which suggested the diagnosis of invasive mole. Surgical treatment (total hysterectomy) was performed with prior administration of chemotherapy with systemic methotrexate. The biopsy confirmed the diagnosis of invasive mole. Invasive mole is one of the forms of presentation of gestational trophoblastic disease. It is a rare condition in which the proliferation of trophoblast and syncytiotrophoblast cells penetrate or even perforate the uterine wall, produce local damage and can invade the parametrial tissue and blood vessels, traveling within these. True metastatic seeding in other organs has not been reported. The clinical evolution was carried out in an outpatient clinic. After two years the evolution is satisfactory, the treatment effective and well tolerated by the patient(AU).

Foi apresentado um caso de doença trofoblástica invasiva por mola. O diagnóstico foi suspeitado com a ultrassonografia do primeiro marcador genético, foram realizadas duas curetagens terapêuticas, sendo que a segunda sugeriu o diagnóstico de mola invasiva. O tratamento cirúrgico (histerectomia total) foi realizado com administração prévia de quimioterapia com metotrexato sistêmico. A biópsia confirmou o diagnóstico de mola invasiva. A mola invasiva é uma das formas de apresentação da doença trofoblástica gestacional, é uma condição infrequente, em que a proliferação de células trofoblásticas e sincitiotrofoblásticas penetram ou mesmo perfuram a parede uterina, produzem destruição local e podem invadir o tecido parametrial e vasos sanguíneos dos vasos. viajando dentro deles, embora verdadeira semeadura metastática em outros órgãos não tenha sido relatada. A evolução clínica foi realizada em ambulatório. Depois de dois anos, o a evolução é satisfatória, o tratamento é eficaz e bem tolerado pelo paciente(AU).

Embarazo molar de 25 semanas con feto vivo: reporte de autopsia / Molar pregnancy with 25-week fetus

Antecedentes: La mola hidatidiforme (MH) se caracteriza por la degeneración hidrópica de las vellosidades coriales, hiperplasia del trofoblasto y se clasifica en completa (MC) y parcial (MP), y difieren en su cariotipo, histopatología, clínica y riesgo de malignidad. Constituye el 1% de las pérdidas fetales en menores de 17 semanas. El objetivo de esta comunicación es exponer un caso de MP con feto de 25 semanas, al cual se le realizó autopsia en el 2014. Caso clínico: Primigesta de 21 años con pobre control prenatal y embarazo de 25 semanas con diagnóstico de preeclampsia y óbito fetal de sexo masculino de 615 g, al que se le solicitó autopsia demostrándose malformaciones múltiples con agenesia del cuerpo calloso, hidrocefalia supratentorial, hipoplasia cerebelosa, meningocele sacro, micropene, hipospadias y retardo del crecimiento intrauterino, la placenta de 750 g demostró hallazgos de enfermedad trofoblástica gestacional de tipo MP. Discusión: La MP presenta vellosidades coriónicas con hiperplasia trofoblástica y feto que tiende a fallecer en una temprana edad gestacional. El feto puede presentar anomalías congénitas secundarias a la aneuploidia y la distinción se basa en histopatología de la placenta, en casos difíciles se emplea citogenética o citometría de flujo. En el presente caso se encontraron características placentarias (degeneración hidrópica vellositaria, inclusiones e hiperplasia trofoblástica) y las malformaciones fetales relacionadas. Conclusión: El estudio histopatológico de la placenta y del producto de la gestación permiten el diagnóstico definitivo para poder determinar el seguimiento de la paciente y disminuir así las complicaciones.

Background: Hydatidiform moles (HM) are characterized by hydropic degeneration of chorionic villi, hyperplasia of the trophoblast and is classified in complete (CM) and partial (PM), and they are different in their karyotype, histopathology, clinical and risk of malignancy. It constitutes 1% of abortion in under 17 weeks. The purpose of this communication is to present a case of PM with 25-week fetus, which fetal autopsy in 2014. Clinical case: Primigravid of 21 years old, with a pregnancy of 25 weeks diagnosed with preeclampsia and stillbirth of 615 g, autopsy demonstrating multiple malformations with agenesis of corpus callosum, hydrocephalus, hypoplasia of the cerebellum, myeloschisis in the sacral region, micropenis, hypospadias and intrauterine growth retardation, the placenta (750 g) has findings of gestational trophoblastic disease type PM. Discussion: The PM has villous tissue with trophoblastic proliferation and fetus tends to die at an early gestational age. The fetus has congenital abnormalities because the aneuploidy, diagnoses is based on histopathology of the placenta, in difficult cases cytogenetic or flow cytometry is used. In this case, placental characteristics (hydropic villus, trophoblastic proliferation and "pseudoinclusions") and related fetal malformations were found. Conclusion: The histopathological study of the placenta and the fetus allow a definitive diagnosis to determine the monitoring of the patient and thus reduce complications.

[Comparison of radiological and pathological results in gestational trophoblastic diseases]

Gestational trophoblastic disease [GTD] is a heterogenous group of neoplastic lesions that is derived from placental trophoblastic epithelium. According to World Health Organization [WHO] classification they include: Hydatidiform mole [complete and partial], invasive mole, choriocarcinoma and placental site trophoblastic tumor. Hydatidiform mole is the most common and the diagnosis is achieved by preevacuation ultrasonographic evaluation, laboratory tests and finally histological assessment as gold standard. Since these disorders show varying potential for local invasion and metastasis, the accurate diagnosis, follow up and recommendations given to patients may differ. Consecutive cases with diagnosis of GTD from archive of pathology department of women [Mirza Kochak Khan] hospital were reviewed in whom results of clinical presentation and pre-evacuation ultrasound examination were documented. There were overall 220 cases for which the following clinical features were determined: gravidity, parity, history of previous abortion and gestational trophoblastic disease, the clinical symptoms such as vaginal bleeding and hypertension. Finally concordance between pre-evacuation ultrasonographic and histological diagnosis by kappa test is calculated. Out of 220 cases with clinically gestational trophoblastic disease diagnosis, 197 cases were confirmed by histological diagnosis. The concluding histological diagnosis includes: 98 cases of complete mole [CM], 84 partial mole [PM], 4 invasive mole and 11 cases of choriocarcinoma. Outside 98 cases with histological diagnosis CM only in 4 cases misdiagnosed by ultrasonoghraphy [4.1%] and high degree of concordance between ultrasonography and histological diagnosis is seen. Ultrasonographic examination accompanied with clinical examination, beside histological assessment as gold standard have high efficacy in diagnosing complete mole. This study did not show this finding for partial mole.

Post-mortem diagnosis of gestation choriocarcinoma: A case report.

The present case demonstrates how a clinico-pathological approach of a forensic pathologist played a key role in deciding a sudden suspicious death and also highlights the characteristics of gestational choriocarcinoma and its importance’s in post mortem diagnosis among the forensic experts and clinicians. Investigating authorities were curious in knowing whether the death was due to criminal abortion or suicidal consumption of poisoning. The case was unraveled so that the rested soul is given justice and free from all defames.

Diagnostico clínico e histopatológico: embarazo molar: presentación de un caso clínico / Clinical and histopatológical diagnostics: molar pregnancy: presentation clinical of a case

La ETG es el término general utilizado para identificar distintos procesos donde existe una hiperplasia de diferentes tipos de epitelio trofoblástico, según la OMS puede clasificarse en 4 tipos: 1) Mola hidatiforme: completa o parcial, más común la primera en un 67 por ciento, 2) Mola invasora (corioadenoma destruens) 3) Coricarcinoma 4)Tumor trofoblástico del lecho placentario, su incidencia varia, pero en países desarrollados se estima sea 1.1/1000 embarazos, siendo esta mas alta en países subdesarrollados se presenta caso clìnico de una paciente la cual se le hace diagnóstico clínico e histopatológico y procedimientos para evacuación uterina por embarazo molar.

Enfermedad del trofoblasto (mola hidratiforme): a propósito de un caso / Disease trofoblástica gestacional (hydatiform mola): a purpose of a case

La enfermedad Trofoblástica Gestacional se caracteriza por proliferación anormal o atípica de las células sincitiales y de langhans de origen ectodermo fetal. Presentación de un tejido extraño (trofoblasto) en los tejidos del huésped (madre) y es tolerada por estos. El tejido invasor es genética y antigéneticamente extraño es el único tumor con este comportamiento en la biología humana. En este trabajo presentamos el caso clínico de un paciente femenino de 20 años primigesta con FUR: 01/10/06 quien consulta por sangrado genital intermitente con vesículas motivo por el cual consulta

Factores maternos que inciden en el diagnóstico de enfermedad trofoblástica gestacional / Maternal factors that impact in the diagnosis of disease trofoblastic gestational

La enfermedad trofoblástica gestacional constituye un grupo de enfermedades propias de la gestación que pueden ser benignas o malignas, caracterizadas por proliferación anormal de las células sinciciales y de Langhans del trofoblasto, que interfieren con el desarrollo embrionario. Clínicamente se presenta como un embarazo normal, ya que hay amenorrea, sialorrea y vómitos, pero existe sangrado, crecimiento uterino no acorde con la edad gestacional, expulsión de vesículas a través de los genitales, útero hipotónico, no se palpan partes fetales, movimientos ni latidos cardíacos. Trabajo tipo descriptivo con medición independiente de variables; retrospectivo, documental, población y muestra de 8 casos luego de revisar las historias clínicas de este centro de salud. 50 por ciento estaban entre 21 a 26 años. El antecedente Ginecoobstétrico predominante fue la multiparidad con 54,5 por ciento, seguido de cesáreas y abortos con 18,18 por ciento respectivamente. El 37,5 por ciento tuvo entre 14 y 18 semanas de gestación, similar porcentaje para las que ignoraban la fecha de última regla. El método quirúrgico más empleado fue el legrado por aspiración con 37,5 porciento. Diagnosticándose finalmente 37 por ciento de mola invasora con un caso de metástasis a pulmón a los 4 años. Es importante destacar que 25 por ciento de las pacientes con diagnóstico clínico y ecográfico no se les practicó biopsia. Se presenta en mujeres en edad fertil, multíparas, durante el primer trimestre de embarazo, se recomienda practicar biopsias a todo material producto de abortos y embarazos anembrionarios.

Gestational trophoblastic disease experience at the basic medical sciences institute, JPMC, Karachi

The study was carried out to evaluate the frequency and types of gestational trophoblastic diseases [GTD] in endometrial and hysterectomy specimen received for histopathology examination. Department of Pathology, Basic Medical Sciences institute, Jinnah Post Graduate Medical Center [JPMC] Karachi. One thousand three hundred forty two cases of endometrial curettage [EC] and 1832 hysterectomy specimens were examined. Out of 1342 cases of endometrial curettage [EC] 242 cases of hydatidiform mole and 5 cases of choriocarcinoma were seen, whereas out of 1832 hysterectomy specimens, 9 cases of invasive mole were seen. Hydatidiform mole was found to be the commonest gestational trophoblastic disease

Radiologic features and treatment outcomes of pulmonary metastasis in gestational trophoblastic neoplasia.

OBJECTIVE: To evaluate the radiologic patterns and treatment outcome of pulmonary metastasis in patients with gestational trophoblastic tumor (GTT). MATERIAL AND METHOD: The medical records and chest films of GTT patients treated at Chiang Mai University Hospital between January 1998 and June 2003 were reviewed. RESULTS: There were 85 GTT-patients in the study period. 32 cases (37.6%) had pulmonary metastasis diagnosed with chest X-rays. The most common radiologic pattern was well defined nodule. The radiologic features of patients who had lung metastases alone were not significantly different from those who had associated metastases in other organs. 27 patients (84.3%) received multiple chemotherapy and 6 required more than one regimen. The mean number of chemotherapy was 7 cycles (range 3-23). Adjuvant surgery consisted of hysterectomy (11), salpingo-oophorectomy (1), thoracotomy (2), and craniotomy (1). Four patients received whole brain irradiation for brain metastases. Among 10 patients with lung metastasis alone, 8 (80%) attained complete remission, the remaining 2 patients were lost to follow-up. Among 22 patients with associated multiple organ metastases, 16 (72.7%) had complete remission, 2 died from diseases, 4 were lost to follow-up. CONCLUSION: The most common radiologic pattern of pulmonary metastasis in GTT patients was well-defined multiple lung nodules. The radiologic features of patients who had lung metastases alone were not significantly different from those who developed metastases in other organs.