Sad fetus syndrome: A case report / Philippine Journal of Obstetrics and Gynecology

@#Sad fetus syndrome is a rare gestational trophoblastic disease wherein a hydatidiform mole coexists with a live fetus. We report a case of a 40‑year‑old G4P2 (2012) with 29 weeks gestational age who came in with vaginal bleeding and labor pains. A previous ultrasound done at 16 weeks of gestation showed a live fetus, a normal placenta, and a focal multicystic uterine mass. The beta‑human chorionic gonadotropin level was 1,500,000 mIU/mL. She delivered a live preterm female fetus weighing 900 g by partial breech extraction. The placenta was grossly normal. Postpartum hemorrhage secondary to uterine atony was encountered and a total hysterectomy with bilateral salpingectomy was performed. Cut section of the specimen revealed molar tissue at the anterofundal area with evidence of gross myometrial invasion. The histopathologic finding was consistent with a diagnosis of partial hydatidiform mole. This paper describes the incidence, pathology, clinical presentation, diagnosis, treatment, and postpartum course of this rare condition.

Partial molar pregnancy with live fetus complicated by intrauterine growth restriction and severe preeclampsia. Case report and review of the literature / Mola parcial con feto vivo, complicado con restricción de crecimiento intrauterino y preeclamsia severa. Reporte de caso y revisión de la literatura

RESUMEN Objetivo: reportar un caso de mola parcial con feto vivo y realizar una revisión de la literatura sobre las complicaciones maternas y fetales asociadas a esta condición. Materiales y métodos: se presenta el reporte de un caso de mola parcial y feto vivo de 33 semanas, complicado por restricción de crecimiento intrauterino, oligoamnios y preeclampsia severa. Después de seguimiento del recién nacido a un año reportamos un resultado satisfactorio materno-fetal. Se realiza una búsqueda de la literatura en Medline vía PubMed, Lilacs, OVID, Uptodate y Google Scholar, con los siguientes términos MESH: "hiditadiform mole", "partial mole", "live fetus", "coexisting live fetus". Se seleccionaron estudios de series de caso y reportes de caso de gestantes con coexistencia de mola parcial y feto vivo al momento del diagnóstico, y se extrajo información sobre el pronóstico materno-fetal. Resultados: se identificaron inicialmente 129 títulos relacionados, de los cuales 29 cumplieron los criterios de inclusión, 4 artículos fueron excluidos por no obtener acceso al texto completo. Se analizaron 31 casos reportados, 9 casos terminaron en aborto, 8 terminaron en óbito o muerte perinatal y 14 (45 %) casos terminaron con un recién nacido vivo. La complicación materna más frecuente fue preeclampsia, en 6 (19,35 %) casos. Conclusión: la coexistencia de mola parcial con feto vivo presenta un riesgo alto de resultado perinatal adverso y preeclampsia. Se requiere más información sobre esta rara condición para determinar de mejor manera posibles intervenciones en los casos de fetos euploides y dar una adecuada asesoría en la práctica clínica, por lo que es importante el reporte de estos casos para tener suficiente evidencia sobre el comportamiento natural de la enfermedad.

ABSTRACT Objective: To report the case of a partial molar pregnancy with live fetus and conduct a review of the literature regarding maternal and fetal complications associated to this condition. Materials and methods: Case report of a partial mole with a 33 weeks live fetus complicated by intrauterine growth restriction, oligohydramnios and severe preeclampsia. We report satisfactory maternal and neonatal outcomes and 1-year follow-up. A search was conducted in the Medline via Pubmed, Lilacs, Ovid, Uptodate and Google Scholar databases using the following MESH terms: hiditadiform mole, partial mole, live fetus, coexisting live fetus. Case series and case reports of pregnant women with coexisting partial mole and live fetus at the time of diagnosis were selected and information regarding maternal and fetal prognosis was extracted Results: Initially, 129 related titles were identified. Of these, 29 met the inclusion criteria, and 4 articles were excluded due to failed access to the full text. Overall, 31 reported cases were included; 9 ended in miscarriage, 8 in fetal demise or perinatal death, and 14 (45 %) resulted in a live neonate. The most frequent maternal complication was preeclampsia in 6 (19.35 %) cases. Conclusion: The coexistence of a partial mole with a live fetus poses a high risk of adverse perinatal outcomes and preeclampsia. The volume of information regarding this rare condition must be increased in order to better determine potential interventions in cases of euploid fetuses and to provide adequate counseling in clinical practice. Therefore, reporting these cases is important to build sufficient evidence about the natural course of this condition.

Incidence of Molar Pregnency on Histopathological Examination- A Retrospective Study

Hydatidiform mole is an abnormal gestation characterized by trophoblastic hyperplasia and overgrowth of placental villi. H. mole is classified as complete (CHM) and partial (PHM). The diagnosis is based on histopathology and genetic origin. In our set up, we used only histopathological diagnostic criteria. The incidence of molar pregnancy varies in different parts of the world. Objective of the present study was to determine the frequency, clinical presentation and morphological features of H. mole and compare them with those of other studies. Objectives: The aim of this populationbased retrospective study was to evaluate the trend in the incidence of molar pregnancy. The reported incidence of GTD in India is in consistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Punjab. Methods: Records of patients of GTD admitted from Dec 2016 to March 2018 were analyzed and incidence was calculated. The diagnosis of hydatidiform mole was based on the post-operative morphological and/or pathological findings. A total of 150 cases of retained products of conception received in the department of pathology were analysed. Results: Out of total 16 cases of molar pregnancy 5 were diagnosed as complete mole and 11 were diagnosed as partial mole. Out of 5 cases of complete mole, one case was of recurrent molar pregnancy. Conclusion: There is a need to look further about the association of age with molar pregnancies in future studies.

Role of the Immunohistochemical Marker (Ki67) in Diagnosis and Classification of Hydatidiform Mole

@#Introduction: Since the hallmark of gestational trophoblastic disease is trophoblastic proliferation, Ki67 is regarded as the best marker in studying hydatidiform mole.This study was conducted to evaluate the role of this proliferative marker in distinguishing among hydropic abortion, partial and complete hydatidiform mole. Materials and methods: This is a cross sectional study involving the application of Ki67 on a total of 90 histological samples of curetting materials from molar (partial and complete mole) and non molar hydropic abortion belong to Iraqi females, so three study groups were created. Immunohistochemical expression in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells were recorded separately by three independent observers and the results were correlated statically. Results: The mean number of stained nuclei of villous cytotrophoblasts and stromal cells was the highest in complete mole and the lowest in non molar hydropic abortion. There is a significant statistical relationship regarding Ki67 labeling index in villous cytotrophoblasts between partial moles and hydropic abortion, complete mole and partial moles, hydropic abortion and complete mole. Regarding Ki67 labelling index in villous stromal cells, a significant statistical relationship achieved when the correlation done between partial mole and hydropic abortions, hydropic abortion and complete mole, while a non significant statistical relationship was achieved if the correlation done between partial and complete mole. All villous syncytiotrophoblasts showed negative results. Conclusion: Ki-67 labeling index in villous cytotrophblastic cells are useful in separating between partial moles and hydropic abortion, partial mole and complete mole, hydropic abortion and complete mole. While Ki-67 labeling index in villous stromal cells is only useful in separating between partial moles and hydropic abortion, hydropic abortion and complete mole.

Displasia mesenquimatosa de la placenta: caso clínico / Placental mesenchymal dysplasia: case report

Placental mesenchymal dysplasia (PMD) is a rare placental anomaly characterized by placentomegaly and grapelike vesicles resembling a molar placenta by ultrasound. A clinical case is presented and we will discuss the differential diagnosis, possible associations and perinatal management.

La displasia mesenquimatosa de la placenta es una anormalidad rara de la placenta caracterizada por una placenta grande con dilataciones quísticas similares a una mola parcial a la ultrasonografía. Se presenta un caso clínico y se discutirá el diagnóstico diferencial, posible asociaciones y manejo perinatal.

Severe preeclampsia at 16 weeks' gestation associated with a partial hydatidiform mole and bilateral theca-lutein cysts / 대한산부인과학회지

We present an unusual case in which a patient was diagnosed with the preeclampsia associated with a partial hydatidiform mole and bilateral theca-lutein cysts. The patient newly developed proteinuric hypertension at 16 weeks' gestation. Ultrasound findings showed small multiple cystic spaces in the placenta and a live singleton fetus. Triploid 69, XXX was confirmed at karyotype analysis. Intrauterine fetal death was found at 18 weeks' gestation and termination of pregnancy was performed, and a partial hydatidiform mole was confirmed at pathologic examination. Torsion of bilateral theca-lutein cysts was developed at postpartum one week. Detorsion and aspiration of the bilateral theca-lutein cysts were performed under the laparoscopy.

A Case of mesenchymal dysplasia of the placenta / 대한산부인과학회지

Placental mesenchymal dysplasia is a rare condition of pregnancy that present as macroscopic feature of molar change in the placenta and normal karyotype fetus, and has been reported at birth in 15 cases of Beckwith-Wiedmann syndrome and 25 cases of normal fetus in literatures. It may mimic the partial hydatidiform mole, but the mesenchymal dysplasia is different that it may be compatible with a normal fetus. A nulliparous woman was suspected to be a partial mole with a coexistent live fetus in gestational age of 14 weeks because of the partially cystic placenta on ultrasonography examination. She delivered a healthy female vaginally at 36+6 weeks of gestation and the histological examination of placenta established the diagnosis of mesenchymal stem villous dysplasia. We report here an unusual pregnancy.

A Case of Choriocarcinoma after Evacuation of Partial Mole / 대한산부인과학회잡지

Persistent gestational trophoblastic tumor develops in about 15-25% after evacuation of complete mole, and arises in about 4-5% after removal of partial mole. Especially there is reported that choriocarcinoma after evacuation of partial mole is extremely rare, and it is well responded to systemic chemotherapy. We have experienced that a case of choriocarcinoma which was developed after evacuation of partial mole. So we report this case with a brief review of literatures.

Term Pregnancy with Partial Molar Changes of Placenta

A rare case report of successful term pregnancy with partial molar changes of placenta is being reported. The patient was 2nd gravida with twin pregnancy with pregnancy induced hypertension (Pili). Patient under went LSCS and gave birth to two healthy looking babies. She was followed up and serum HCG (Human Chorinic Gouadotrophin) level returned to normal within 4 weeks after delivery.

Genetic study of hydatidiform moles by restriction fragment length polymorphisms (RFLPs) analysis

Twenty three hydatidiform moles (HMs) were studied using the techniques of "RFLPs" employing a minisatellite deoxyribonucleic acid probe. Among the 23 HMs, 17 were homozygous types resulting from a duplicated haploid sperm, and two were heterozygous types resulting from fertilization two independent sperms (dispermy). It was revealed that the four histopathologically diagnosed complete HMs (CHMs) were partial HMs (PHMs) with one maternal and 2 paternal chromosome contribution (diandry) or two maternal and 1 paternal alleles (digyny). The locus specific minisatellite probes were useful in classifying CHM into heterozygous and homozygous types as well as in diagnosing PHM. One heterozygous (50%) and 5 homozygous (29.4%) CHMs, and one PHM (25%) progressed to persistent gestational trophoblastic disease (p > 0.5).