Abstract
Complete hydatidiform mole is an abnormal pregnancy that usually presents with vaginal bleeding and markedly elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 16-year-old nulligravid who presented with a 34-week size uterus and a relatively low serum ß-hCG level (722 IU/L)—likely related to the “hook effect”—and severe anemia (hemoglobin: 6.1 g/dL) despite the absence of vaginal bleeding. She also reported right flank pain and was diagnosed with moderate right hydronephrosis owing to the compression exerted by the enlarged uterus on the right ureter. The patient received a total of 6 units of packed red blood cells and was managed by dilation and evacuation followed by serial monitoring of serum ß-hCG levels. Therefore, complete mole can present with symptoms related to an enlarged uterus and severe anemia before the occurrence of vaginal bleeding. It is also important to note that a negative urine pregnancy test or relatively low serum ß-hCG level should prompt repeating the measurement on diluted sample to prevent the “hook effect.”
Highlights
A hydatidiform mole is an abnormal pregnancy that is characterized by trophoblastic proliferation and villous edema within the placenta [1]
We report a rare case of complete molar pregnancy who presented with an enlarged uterus and symptoms related to the compression on adjacent organs, severe anemia despite the absence of vaginal bleeding, and a relatively low serum ßhCG level owing to the “hook effect.”
The widespread use of ultrasonography in early gestation and the enhanced accuracy of β-hCG assays have led to earlier diagnosis of molar pregnancy and subsequently changed its classical clinical presentation [9, 10]
Summary
A hydatidiform mole is an abnormal pregnancy that is characterized by trophoblastic proliferation and villous edema within the placenta [1]. Partial moles are characterized by the presence of fetal or embryonic tissues, chorionic villi of different sizes featured by their focal trophoblastic hyperplasia and focal swelling, and marked villous scalloping [2]. Complete moles are characterized by the absence of embryonic or fetal tissues, diffuse trophoblastic hyperplasia and hydropic swelling of villi, and marked atypia of trophoblast at the implantation site [2]. The majority of complete moles present with vaginal bleeding and markedly elevated ß-hCG values [3, 4]. We report a rare case of complete molar pregnancy who presented with an enlarged uterus and symptoms related to the compression on adjacent organs, severe anemia despite the absence of vaginal bleeding, and a relatively low serum ßhCG level owing to the “hook effect.”
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