Case Of Invasive Mole Research Articles

Perimenopausal invasive complete hydatidiform mole: a rare encounter

Invasive mole, classified under the gestational trophoblastic diseases, comprises of hydropic chorionic villi invading the underlying myometrium, blood vessels or extra-uterine sites. They are usually diagnosed clinically and are treated with chemotherapy. Thus, surgery is rarely performed owing to good response to chemotherapy and preservation of fertility, since most women are in reproductive age. Thus, these specimens are rarely encountered by the pathologists. Here, we report a case of invasive mole in a 48 year old female with persistent elevation of serum beta HCG levels and completed family status who underwent hysterectomy and was diagnosed as a case of invasive mole on histopathologic examination.

Invasive Mole of the Uterus: A Case Report

Invasive mole is a rare subgroup of gestational trophoblastic disease characterized by the invasion of molar tissue into the myometrium or uterine vasculature. In this paper, we report the third case of invasive mole described in the Malagasy literature. A 33-year-old woman was referred to the Soavinandriana Hospital, her complaint was persistent vaginal bleeding during 2 months, occurring at 3 months of pregnancy with biological anemia without hemodynamic repercussions. The human chorionic gonadotropin (HCG) level was 385,931 mIU/ml. A haemostasis hysterectomy was performed. Histological examination showed an enlarged uterus and endometrial cavity containing edematous chorionic villi with trophoblastic proliferation invading the myometrium. The diagnosis was an invasive mole, stage I, FIGO score 6. Chemotherapy was prescribed but was not honored. After 45 days of follow-up, the serum βHCG level decreased to 1803 mIU/ml, without clinical symptoms. The patient then lost sight. Persistent vaginal bleeding after pregnancy may be the only clinical symptom of an invasive mole and should raise suspicion. Histological examination establishes the diagnosis. As this is an unusual cause of vaginal bleeding, our case should remind physicians that when faced with this symptom, the possibility of an invasive mole should be considered in order to make an early diagnosis for less aggressive treatment.

A Five-Year Retrospective Study of Gestational Trophoblastic Disease at University of Maiduguri Teaching Hospital Maiduguri, Nigeria

Background: Gestational trophoblastic disease (GTD) is an uncommon complication of pregnancy. It is of clinical and epidemiological interest partly because of its good prognosis if detected and managed early. Objective: This study was to determine the prevalence, clinical presentation, management outcome and histologic types of GTDs at University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Methodology: A five-year retrospective study of histologically confirmed cases of GTDs managed in UMTH was undertaken. Folders of patient treated for GTD during the study period served as source of data. Statistical analysis was done using Statistical Package for the Social Sciences. Results: There were a total of 47 (38 molar and 9 choriocarcinoma) cases of GTDs that were diagnosed and managed at UMTH. However, only 40[31(77.5%)] molar and [9(22.5%) choriocarcinoma] case files were retrieved. 55% of the GTDs were complete hydatidiform mole, 22.5% partial hydatidiform mole and 22.5% choriocarcinoma. There was no case of invasive mole or placental site trophoblastic tumour noted. There were 15,426 deliveries in UMTH during this period giving the incidence of GTDs as 3.0 per 1000 deliveries or 1 in 328deliveries. The mean (SD) age of the patients was 30.5 ± 5.6years. Only 3(7.5%) of the patients were below 20 years of age and those who were at least 40 years of age constituted 8(20%). Low parity constituted 62.5% of the patients while 12.5% and 2.5% were nullipara and primipara respectively. The mean gestational age (SD) at presentation was 16.5±6.2 weeks. The common clinical presentations were amenorrhoea (100.0%), abnormal vaginal bleeding (97.5%), lower abdominal pain (90%) and passage of grape-like vesicles (45.0%). Only 6(15.0%) complied with the follow-up protocol for one year, while 25(62.5%) of the patients did not observe the follow-up protocol. Anaemia was the commonest complication observed. Conclusion: Gestational trophoblastic disease is relatively common in our center with an incidence of 3.0 per 1000 deliveries and 1.48% of our gynaecological admissions. Adequate patient counseling and compliance to follow-up are recommend for good outcome. Keywords: Prevalence, gestational trophoblastic disease, Hydatidiform mole, Choriocarcinoma, Maiduguri.

The Role of Ultrasound in the Diagnosis and Management of Trophoblastic Diseases (TMD) at the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou

Objective: To describe the place of ultrasound in the diagnosis and management of Gestational Trophoblastic Diseases (GTD) at the Ouagadougou UTH-YO, Ouagadougou, Burkina Faso. Materials and Patients: It was a prospective and descriptive study over a 3-year period from 1 January 2015 to 31 December 2017. It took place in the gynecology and obstetrics department of at the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou. Monitoring was based on clinical examination data, ultrasound and kinetics of β-gestational chorionic hormone (GCH) levels. Results: During the study period, we recorded 34 cases of trophoblastic diseases. The average age of the patients was 35 years with extremes of 22 and 52 years. Physical examination revealed a uterus larger than gestational age in 17 patients (56.67%) of cases. Eight (26.67%) patients were asymptomatic. The initial mean β-GCH was 453,747.8 IU/l with extremes of 5903 IU/l and 1,890,000 IU/l. Ultrasound was used to evoke the diagnosis in 23 patients, that to say 76.67% of the cases. Ultrasound identified 10 complete mole cases, 20 partial mole cases. For the 3 cases of invasive mole, pelvic ultrasound revealed heterogeneous intrauterine multi-vesicular images. In a case of choriocarcinoma, ultrasound found an enlarged uterus with a poorly limited intracavitary heterogeneous fundic image. Conclusion: This short series shows the central role of ultrasound in the diagnosis and follow-up of gestational trophoblastic diseases. Indeed, the sensitivity of ultrasound is excellent in the early diagnosis of complete moles. Ultrasonography remains a good examination choice for the diagnosis of gestational trophoblastic tumors despite their great polymorphism. The place of ultrasound in prognostic evaluation and treatment monitoring deserves to be studied by more important series.

A Case of Invasive Mole

Invasive mole is a condition where a molar pregnancy, such as a partial hydatidiform mole or complete hydatidiform mole, invades the wall of the uterus, potentially spreading and metastasizing to other parts of the body. Here is a case who presented with history of evacuation for molar pregnancy. She presented with irregular P/V bleeding on and off and after admission silent perforation with massive haemoperitoneum was detected for which emergency laparotomy was done. She recovered and was followed up till her b-hCG levels were within normal limits. As patient presented to us with haemoperitoneum and on laparotomy, there was invasion into whole of the uterus, it could not be saved and hysterectomy was done.Faridpur Med. Coll. J. Jul 2017;12(2): 86-87

Histomorphological Study of Gestational Trophoblastic Lesions in a Tertiary Medical Centre: A Prospective Study

Background: Gestational trophoblastic diseases(GTDs) consists of pregnancy related disorders ranging from benign Hydatidiform mole, Invasive mole to neoplastic conditions including Choriocarcinoma, Placental site trophoblastic tumor and Epitheloid trophoblastic tumor with varying potential for local invasion and metastasis. GTDs mimic growth pattern encountered in early normal placental development, nonmolar abortions and variety of nontrophoblastic lesions. Therefore an appreciation of different types of GTDs with its histomorphological manifestations are important for the confirmation of diagnosis. Thus the study was undertaken. Materials & methods: The material for the study comprised of products of conception specimens received in the Department of Pathology, J.J.M. Medical college, Davangere, India during the period of 2 years. Detailed gross examination was done before fixation and subsequent microscopic analysis was done. Results: 65 cases of GTDs were diagnosed in 495 cases of products of conception. 37 cases of complete mole, 27 cases of partial mole and one case of Invasive mole were diagnosed. Diffuse hydropic swelling of the villi, round smooth villous outline, circumferential trophoblastic proliferation and focal hydropic swelling of the villi, irregular scalloping outline of the enlarged villi, focal trophoblastic cell proliferation were characteristic features of complete & partial mole respectively. Histomorphological features were analysed in all the cases and compared with studies done by others. Conclusion: The classification and histomorphological analysis of GTDs are important elements for better understanding of the disease. Studies are needed to look for ancillary markers in distinguishing different types of GTDs and for predicting the prognosis. DOI: 10.21276/APALM.1193

Toxic Effect of Chemotherapy (Even When Used in Conventional Dose) and Dealing with That Toxicity Effectively: A Case Report

Background: Use of Chemotherapy is a double edged sword apart from destroying malignant cells it also has life threatening complications, so clinician should be ready to counter the complication while also dealing with malignancies. Case Report: We report a case of Invasive Mole who after initiation of first cycle of chemotherapy (5 Fluorouracil and Dactinomycin) developed Gastrointestinal and Myelosuppression related complications. Conclusion: Extreme Knowledge of Clinicians is a must to deal with infections and other potential complications while using chemotherapy.

Gestational trophoblastic disease in Abuth Zaria, Nigeria: A 5-year review

Gestational trophoblastic diseases (GTD) includes a spectrum of diseases (tumor or tumor-like conditions) characterised by aberrant growth and development of the trophoblasts that may continue even beyond the end of pregnancy. It encompasses the benign trophoblastic disease (complete and partial moles), and the malignant trophoblastic diseases including the invasive mole (chorioadenoma destruens), choriocarcinoma, and Placental Site Trophoblastic Tumor (PSTT). This study was to determine the prevalence, risk factors, clinical presentation, diagnosis, treatment options and outcomes of GTD in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. A five-year retrospective study of patients with GTD managed at ABUTH, North-west Nigeria, from 1 st January 2008 to 31 st December, 2012 was undertaken. Data of all cases of GTD in the hospital over the 5 year period were obtained. The gynaecology ward and labour ward registers also provided information on the total number of gynaecological admissions and deliveries respectively. The data processing and analysis were carried out using the SPSS software version 16. The data obtained were expressed in percentages, means, and standard deviations. During the period of study there were 8,138 deliveries and 2,453 gynaecological admissions. There were 59 cases of GTD with 41 having choriocarcinoma, 18 molar pregnancies and no case of invasive mole or PSTT. Out of the 41 case folders retrieved, 23 were choriocarcinoma and 18 of molar pregnancies. The prevalence of GTD was 7.2 per 1000 deliveries (0.72% or 1 in 138 deliveries) and constituted 2.4% of gynaecological admissions. Hydatidiform mole (HM) occurred in 1 in 452 deliveries and choriocarcinoma occurred in 1 in 198 deliveries. Ages ranged from 19-49 years with mean of 32.5+ 5.0 years. Most (66.7%) cases of HM were 19-29years while 60.9% of choriocarcinoma cases were 30-39years. Majority of cases were multiparous. The antecedent events predating choriocarcinoma were Hydatidiform mole (31.7%), abortions (29.3%) and 2.4% followed term pregnancy. History of amenorrhea was present in all cases while vaginal bleeding occurred in 97.6%, pallor (87.8%), hyperemesis gravidarum (48.8%) and 4.9% came in shock. Consequently, common complications reported were haemorrhage (90.2%), anemia (87.8%) and shock (12.2%). Pregnancy test was positive in 90.2% of cases and serum beta hCG was done in 24.4% with more than half having a level >12,000miu/ml. All patients had pelvic ultrasound scan and snowstorm appearance occurred in 41% of benign GTD cases. Histology was used to confirm 56.1% cases of choriocarcinoma and 43.9% of molar gestation. Most (94.4%) of HM had suction evacuation while 95.6% of choriocarcinoma cases had chemotherapy, one case (2.4%) had Total Abdominal Hysterectomy. Contraception was used in 78% and common methods were male condom (41.5%) and 36.6% used combined oral contraceptive pills. Less than half (43.9%) had follow up for 6 months and 9.8% were seen for more than a year. Eight patients had subsequent pregnancies and there was one death in the series giving a case fatality of 2.4%. Gestational trophoblastic disease is a significant source of maternal morbidity with increased risk of mortality from complications if not detected early and treated promptly.

A Rare Case of Invasive Mole with Silent Uterine PerforationA Case Report

A Rare Case of Invasive Mole with Silent Uterine PerforationA Case Report

Hydatidiform mole as seen in a university teaching hospital: A 10-year review

SummaryHydatidiform mole (HM), is a known cause of early pregnancy wastage and has the risk of malignant potential. This is a retrospective study of 71 patients who were managed for hydatidiform mole at the University of Maiduguri Teaching Hospital, (UMTH) Maiduguri over a 10-year period, from January 1996 to December 2005, inclusive. The objective of the study was to determine the incidence, risk factors, clinical presentations and histological types of HM. Case records of 71 histologically confirmed HM were studied. Their sociodemographic characteristics, clinical presentations and histology reports were obtained and analysed. The institutional incidence of molar pregnancy was 3.8/1,000 deliveries. Histological findings showed partial mole in 51 (71.8%) cases and complete mole in 20 (28.2%) cases. The peak age-specific incidence rate was 17.5 years. The leading presenting clinical feature was abnormal vaginal bleeding seen in 100%. No case of invasive mole was found. Maternal complications included severe haemorrhage requiring blood transfusion (30.0%) and infections (15.5%). There was no maternal death. In conclusion, the incidence of partial hydatidiform mole was found to be higher than that of complete variety in our environment and the identified risk factors were young age, low parity and previous history of HM.

The role of KiSS-1 and matrix metalloproteinase-9 in regulation of invasion of trophoblasts

To explore the role of metastasis-related gene KiSS-1 and matrix metalloproteinase (MMP)-9 in regulation of invasion of trophoblasts. RT-PCR and Western blotting were used to detect the MMP-9 and KiSS-1 expression levels in the placental tissues obtained from 90 cases of normal pregnant women undergoing artificial abortion, induction of labor with water bag or selective cesarean section among which 30 cases were in the first trimester, 30 in second-trimester and 30 cases of term pregnancy, and in the placental tissues of 40 cases of preeclampsia (15 cases of mild and 25 cases of severe preeclampsia) undergoing cesarean section, and tissues of 90 cases of hydatidiform mole, 9 cases of invasive mole and 8 cases of choriocarcinoma, all undergoing surgery. The expression levels of MMP-9 mRNA and protein were higher in first-trimester [A value 0.391 +/- 0.215, (36 +/- 7) microg/100 microg total protein] and then decreased gradually with the progress of gestation. The expression levels of MMP-9mRNA and protein in the term placental samples were significantly lower than those of first-trimester (both P < 0.01). The expression levels of KiSS-1mRNA and metastin in normal placenta increased along with the progress of gestation (both P < 0.01). The KISS-1 mRNA expression level and MMP-9 protein expression level in the placental tissue of preeclampsia were 0.09 +/- 0.06 (A value) and (9.6 +/- 4.3) microg/100 microg total protein respectively, both significantly lower than those of the term placenta (both P < 0.01). The expression levels of MMP-9 mRNA and protein in the tissues of gestational trophoblastic disease were significantly higher than those in the first-trimester placenta (both P < 0.01). The expression level of KISS-1 mRNA and metastin in the tissues of hyddatidiform mole and invasive mole were both significantly lower than those in the first trimester placenta (P < 0.05, P < 0.01). The expression of KiSS-1mRNA and metastin in the tissues of choriocarcinoma could not be detected. The expression of the invasion-related gene, MMP-9, is positively related with, while the invasion suppressor gene, KiSS-1, is negatively related with the invasive ability of trophoblasts. The interaction of these two genes plays an important role in regulation of the invasion of trophoblasts.

A Case of Invasive Mole with Uterine Rupture Presenting as a Hemoperitoneum

Invasive mole is defined as the invasion of molar villi into myometrium or the metastasis on several organs from hydatidiform mole. It is not understood accurately, because this disease is clinically occult and the diagnosis is usually made on the basis of hysterectomy. An invasive mole causing uterine rupture is a rare occurrence. We describe below a case with an unusual hemoperitoneum finding. The patient underwent total abdominal hysterectomy and pathologic examination indicated invasive mole. A brief reviews of related literatures was done.

Choriocarcinoma diagnostic score: A scoring system to differentiate choriocarcinoma from invasive mole

Okamoto T, Nomura S, Nakanishi T, Goto S, Tomoda Y, Mizutani M. Choriocarcinoma diagnostic score: A scoring system to differentiate choriocarcinoma from invasive mole. Int J Gynecol Cancer 1998; 8: 128–132. The histologic diagnosis of choriocarcinoma has been reported to be one of the prognostic factors for the treatment outcome of gestational trophoblastic tumors (GTT). A scoring system, called the choriocarcinoma diagnostic score (CD score), which had been devised to differentiate choriocarcinoma from invasive mole, was reevaluated in patients with GTT treated at Nagoya University Hospital from 1964 to 1996. There were 134 cases with pathologic documentation of choriocarcinoma and 155 cases of invasive mole. Sensitivity of the CD score (ie the true positive rate for the histologic diagnosis of choriocarcinoma) was 94.0%, and specificity of the score (ie true positive rate for the histologic diagnosis of invasive mole) was 97.4%. Thus, the accuracy of the score was very high (95.8%). Seventy-two (91.2%) of 79 cases with high CD scores (10 points or more) were categorized into high-risk or very high-risk groups according to the World Health Organization (WHO) prognostic index score. This unique scoring system should be included in the management of patients with GTT.

A Case of Invasive Mole Initially Presenting with Symptoms of Brain Metastasis

A Case of Invasive Mole Initially Presenting with Symptoms of Brain Metastasis

A Case Report of Invasive Mole with Uterine Rupture

A case of invasive mole causing uterine perforation is a rare occurrence. We describe a patient who had an acute surgical abdomen. Exploration of the peritoneal cavity revealed uterine perforation and hemoperitoneum. A total abdominal hysterectomy was necessary because of extensive uterine wall damage and to ensure hemostasis. Pathologic examination of the tissue revealed an invasive mole with a focal rupture of the uterus. (J GYNECOL SURG 10:89, 1994)

Pregnancy after Chemotherapy for Trophoblastic Diseases and Psychosomatic Developmentin the Progeny*

We treated 542 patients with trophoblastic diseases from 1965 through 1988, and succeeded in preserving fertility in 269 of them (240 cases of invasive mole and 29 cases of choriocarcinoma). Of the 269 patients, 198 (79.5%) conceived after completing treatment. A total of 396 pregnancies in these women resulted in 295 term live births (74.5%), 51 spontaneous abortions (12.9%), and 4 recurrences of moles (1.0%). Four cases (1.32%) of malformations were discovered. The growth conditions of 101 children born in 1976 or later were followed up until the age of 18 months. Their heights or weights did not differ significantly from those of children measured in national infantile-growth surveys. The psychoneurological development of 54 children up to the age of 7 years who were studied by using infantile mental-development questionnaires showed no marked mental retardation. Our results provide strong evidence of the safety of chemotherapy for the treatment of trophoblastic diseases.

Identification of the pregnancy responsible for gestational trophoblastic disease by DNA analysis

In three cases of choriocarcinoma, genetic loci including a variable number of tandem repeat regions were amplified by the polymerase chain reaction method on DNA from three established cell lines and from lymphocytes of patients and their husbands to identify the responsible pregnancy. Case 1, from whom NaUCC-3 was derived, had only one full-term fetal death. Case 2, from whom NaUCC-4 was derived, had one normal delivery followed by one complete molar delivery and one normal delivery. Case 3, from whom NaUCC-2 was derived, had one normal delivery followed by one complete molar delivery. In case 1, NaUCC-3 was found to be of parental origin and derived from the pregnancy with full-term fetal death. In cases 2 and 3, NaUCC-4 and NaUCC-2 were of probable androgenetic origin and were derived from the pregnancy with complete hydatidiform mole. We also conducted the restriction fragment length polymorphism method using case 1 samples, and it confirmed the results based on the polymerase chain reaction method product patterns. All nine cases of hydatidiform mole and three cases of invasive mole were of androgenetic origin. The polymerase chain reaction method thus makes it possible to identify easily the pregnancy responsible for choriocarcinoma using only a few specimens without isotopes.

Perforation of the uterus by an invasive mole using color Doppler ultrasound: case report.

A case of invasive mole is presented. The diagnosis made using transabdominal color Doppler ultrasound was confirmed by the subsequent surgical removal of a large tumor. The authors suggest that the use of transabdominal color Doppler ultrasound shows encouraging promise in such cases and should be considered in addition to pelvic arteriograms.

Repeat Curettage After Evacuation of Hydatidiform Mole

In the management of patients with molar pregnancy, a repeat uterine curettage is generally advocated after evacuation of the hydatidiform mole. To assess the usefulness of a repeat curettage, we reviewed our experience with this procedure over an 8-year period. We found that it was unnecessary in 90% of the cases and did not predict or influence the outcome in all but one case of invasive mole. We feel that the procedure is not cost-effective and should be reserved for patients with specific indications such as incomplete evacuation and abnormal uterine bleeding.

Diagnostic Reliability of Simultaneous Measurements of Beta Human Chorionic Gonadotropin and Pregnancy-Specific Beta-1-Glycoprotein in Serum of Patients with Trophoblastic Disease

Serum levels for beta-human chorionic gonadotropin (beta-hCG) and pregnancy-specific beta 1-glycoprotein (SP1) in patients with trophoblastic disease were measured by radioimmunoassay and enzyme-linked immunosorbent assay. The beta-hCG:SP1 ratios were below 1.0 in all 22 cases of complete hydatidiform mole and in 8 of 9 cases of partial hydatidiform mole. Two (10.5%) of 19 cases of invasive mole involving metastasis had ratios that rose above 1.0 during chemotherapy. Ratios ranged from 1.6 to 29 in 11 of 15 cases of choriocarcinoma before chemotherapy. The remaining 4 cases, diagnosed within 3 months of antecedent pregnancy, had ratios below 0.99. Thus, the difference between choriocarcinoma and nonchoriocarcinoma beta-hCG:SP1 ratios may be due to trophoblastic differentiation based on the developmental stage and with trophoblast age, or due to the mass and potential activity of trophoblastic cells.