G07 - The complex management and treatment of hydatidiform mole: our experience

Abstract

Background: Hydatidiform mole (HM) is a rare disorder of trophoblast. HM comprises two distinct entities, the partial mole (PM) and complete mole (CM). The HM usually occurs with vaginal bleeding, increased serum levels of beta-hCG and, sometimes, uterus larger than typical gestational age. The PM comes up with a more moderate symptoms.Patients and methods: From April 2012 to April 2016 were evaluated all patients with histopathologic diagnosis of HM, partial or complete, and we monitored the progress of disease through beta-hCG, transvaginal ultrasonographic examination (TVUS) and abdominal ultrasound and chest x-ray in patients with indication for chemotherapy, and we have undergone them suction curettage (SC) at the moment of diagnosis. All patients were given the opportunity to psychological support.Results: In the 4 years of study we have been taken over by our center 10 patients, 5 with histopathologic diagnosis of MC and 5 patients with PM. Median age at diagnosis was 26 years. All patients were submitted in response to a symptomatology characterized by abdominal pain, bleeding and subsequent finding of miscarriage between 8 and 12 weeks of gestation. The dosage of beta-hCG serum before surgery presented values between 38689.0 mU/ml and 223900.0 mU/ml. Of all patients evaluated, 3, two with CM and one with PM, showed high levels after 8 weeks after SC and were then subjected to treatment with methotrexate 50mg im on days 1,3,5,7 and folic acid 7.5mg 2 tablets in the days 2,4,6,8 every 2 weeks until detection of 3 negative consecutive doses of beta–hCG. In all the patients the treatment was carried out for 6-8 weeks with negative levels of beta-hCG already after the first 2 weeks of treatment. The treatment was well tolerated and not burdened by side effects (expecially grade 3-4). At the end of chemotherapy patients have continued follow up with monthly beta-hCG for 6 months in the case of PM and for 12 months in the case of CM. A gynecological examination with TVUS was performed every 4 months. To date none of the patients showed signs of relapse.Conclusions: Given the young age of patients and the delicate nature of the disease, HM should be treated in reference institutions where a multidisciplinary team including oncologist, radiologist, gynecologist and psychologist can manage the diagnosis and the treatment of this pathology and any sequelae related to it. Background: Hydatidiform mole (HM) is a rare disorder of trophoblast. HM comprises two distinct entities, the partial mole (PM) and complete mole (CM). The HM usually occurs with vaginal bleeding, increased serum levels of beta-hCG and, sometimes, uterus larger than typical gestational age. The PM comes up with a more moderate symptoms. Patients and methods: From April 2012 to April 2016 were evaluated all patients with histopathologic diagnosis of HM, partial or complete, and we monitored the progress of disease through beta-hCG, transvaginal ultrasonographic examination (TVUS) and abdominal ultrasound and chest x-ray in patients with indication for chemotherapy, and we have undergone them suction curettage (SC) at the moment of diagnosis. All patients were given the opportunity to psychological support. Results: In the 4 years of study we have been taken over by our center 10 patients, 5 with histopathologic diagnosis of MC and 5 patients with PM. Median age at diagnosis was 26 years. All patients were submitted in response to a symptomatology characterized by abdominal pain, bleeding and subsequent finding of miscarriage between 8 and 12 weeks of gestation. The dosage of beta-hCG serum before surgery presented values between 38689.0 mU/ml and 223900.0 mU/ml. Of all patients evaluated, 3, two with CM and one with PM, showed high levels after 8 weeks after SC and were then subjected to treatment with methotrexate 50mg im on days 1,3,5,7 and folic acid 7.5mg 2 tablets in the days 2,4,6,8 every 2 weeks until detection of 3 negative consecutive doses of beta–hCG. In all the patients the treatment was carried out for 6-8 weeks with negative levels of beta-hCG already after the first 2 weeks of treatment. The treatment was well tolerated and not burdened by side effects (expecially grade 3-4). At the end of chemotherapy patients have continued follow up with monthly beta-hCG for 6 months in the case of PM and for 12 months in the case of CM. A gynecological examination with TVUS was performed every 4 months. To date none of the patients showed signs of relapse. Conclusions: Given the young age of patients and the delicate nature of the disease, HM should be treated in reference institutions where a multidisciplinary team including oncologist, radiologist, gynecologist and psychologist can manage the diagnosis and the treatment of this pathology and any sequelae related to it.