2011-06-03-15 Complete hydatidiform mole © Iacovache www.TheFetus.net
Complete hydatidiform mole
Tudor Iacovache, MD.*, Monica Hincu, MD.**
* Department of Obstetrics and Gynecology, Brasov, Romania.
** Department of Histopathology, Brasov, Romania.
This is a 26-year-old G2 P1 patient was admitted to the hospital at 18 weeks of her pregnancy for vaginal bleeding. The ultrasound images showed placenta previa, the “previa” part of the placenta had multiple small cysts.
We raised a suspicion of hydatidiform mole based on the ultrasound images of the placenta. Laboratory tests showed very high levels of beta hCG 316,000 U.I. Pregnancy continued uneventfully.
The ultrasound scan at 23 weeks showed a normal fetal growth and normal anatomy. Placenta was posterior and it's cystic part has grown in size, and was covering the cervical os.
During the following weeks patient was admitted two more times for episodes of vaginal bleeding. At 28 weeks after a last episode of bleeding the speculum exam revealed a tissue mass protruding from the external cervical os. Tissue mass was removed and sent for the pathology exam. The follow-up ultrasound next day showed no sign of the cystic placental mass. Placenta was low-lying posterior and of normal appearance.
There was no more bleeding for the next four weeks. The premature labor started at 32 weeks, and the fetus was delivered via cesarean section. The neonatal weight was 1600 grams and the postnatal course was uncomplicated. The placenta was macroscopically normal, some parts of the membranes had a rough texture.
Pathology of the tissue removed from the cervical os was described as a necrotic tissue. Pathology from the placenta, the rough part of the membranes, was consistent with the diagnosis of complete mole.
Levels of beta hCG were followed-up after delivery. The hCG level reached plateau of 900 U.I. 6 weeks after delivery. The ultrasound showed intrauterine tissue and multiple ovarian cysts. Dilation & Curettage was performed and followed by a decrease of beta hCG to undetectable levels over the following 3 months.
We assume that this was a case of a twin pregnancy with a complete mole. We have found some case reports of twin pregnancy with a complete hydatidiform mole but this one is unusual because the molar pregnancy was eventually aborted.
Images 1,2: 18 weeks, images of the placenta showing multiple cysts.
Image 3: Image of the fetal head and posterior placenta.
Images 4-7: 23 weeks, Images of the cystic part of the placenta located above the internal cervical os.
Images 8,9: 27 weeks, Images of the cystic part of the placenta.
Images 10,11: Image 10 shows the posterior portion of the placenta which was of normal appearance. Image 11 shows the male gender.
Images 12,13: Image 12 shows the axial view of the fetal head. Image 13 shows a normal 4-chamber-view.
Images 14,15: 28 weeks, Image 14 shows a normal looking placenta. Image 15 shows a transvaginal scan of the uterine cervix, no cystic portion of the placenta was visible.
Video 1,2: 23 weeks, videos of the placenta, note the cystic part of the placenta located in the lower uterine segment.
Images 16,17: Pathology images showing vesicular swelling of chorionic villi and trophoblastic hyperplasia (eosinophilic clusters). Image 16 shows a proliferation of cytotrophoblast and syncytiotrophoblast around the villi. Image 17 shows a large villus distended with stromal fluid.
Images 18,19: proliferation of the cyto and syncytiotrophoblast around the villi.
Images 20-22: Images of the distended villi lined by trophoblast.