Gestational Trophoblastic Disease

Abstract

A middle-aged woman presented with vaginal bleeding leading to the identification of a uterine mass and serum hCG level of more than 700,000 mIU/mL. Imaging revealed no evidence of a gestational sac or fetal pole. She underwent hysterectomy. The photograph is of a bisected uterus containing a network of vesicular villi connected by fibrous strands historically referred to as resembling a “cluster of grapes.” Which of the following type of gestational trophoblastic disease does this patient most likely have?a.Nonmolar gestation with hydropic degenerationb.Partial hydatidiform molec.Complete hydatidiform mole (CHM)d.Choriocarcinoma Answer: c. Complete hydatidiform mole Complete hydatidiform mole is a form of gestational trophoblastic disease that results from fertilization of an abnormal empty ovum by 2 sperms or 1 sperm that replicates.1Di Cintio E. Parazzini F. Rosa C. Chatenoud L. Benzi G. The epidemiology of gestational trophoblastic disease.Gen Diagn Pathol. 1997; 143: 103-108PubMed Google Scholar, 2Lindor N.M. Ney J.A. Gaffey T.A. Jenkins R.B. Thibodeau S.N. Dewald G.W. A genetic review of complete and partial hydatidiform moles and nonmolar triploidy.Mayo Clin Proc. 1992; 67: 791-799Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar It is estimated to occur at a rate of 1 per 1000 pregnancies in the United States.1Di Cintio E. Parazzini F. Rosa C. Chatenoud L. Benzi G. The epidemiology of gestational trophoblastic disease.Gen Diagn Pathol. 1997; 143: 103-108PubMed Google Scholar Most CHMs are diploid, with 46,XX being the most common karyotype.1Di Cintio E. Parazzini F. Rosa C. Chatenoud L. Benzi G. The epidemiology of gestational trophoblastic disease.Gen Diagn Pathol. 1997; 143: 103-108PubMed Google Scholar, 2Lindor N.M. Ney J.A. Gaffey T.A. Jenkins R.B. Thibodeau S.N. Dewald G.W. A genetic review of complete and partial hydatidiform moles and nonmolar triploidy.Mayo Clin Proc. 1992; 67: 791-799Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar No fetus develops, but the placental tissue develops as a mass of vesicular villi, each about 1 cm, that fills the uterine cavity. Microscopy shows enlarged villi with central cisterns, stromal karyorrhexis, and a circumferential pattern of mixed trophoblastic hyperplasia (arrow). Complete evacuation is often sufficient treatment, and serum hCG is serially followed until it returns to 0. Because of increased risk (2%-3%) of choriocarcinoma in CHM, hysterectomy is often performed in patients older than 40 years.