Overview
Epidemiology
- Occurs in about 1 pregnancy in 1,200 pregnancies in the United States, with hydatidiform mole representing 80 percent of the cases. Higher incidence in Southeast Asia and Japan
- Risk factors:
- History of gestational trophoblastic disease (GTD)
- History of prior spontaneous abortion and/or infertility
- Protein, folic acid, and carotene deficiency
Classification
- Hydatidiform moles: considered premalignant because of their potential for malignancy
- Complete mole
- Partial mole
- Invasive moles
- Choriocarcinoma: incidence USA 1/40,000
Hydatidiform Mole
Hydatidiform moles are characterized by cystic swelling of the chorionic villi and proliferation of the chorionic epithelium. There are 2 types: complete mole and partial mole.
| Complete mole | Partial mole | |
|---|---|---|
| Karyotype | 46,XX or 46,XY | Triploid (69,XXX, 69,XXY, or 69,XYY) |
| Formed from | Enucleated egg and a single sperm | 2 sperm and 1 egg |
| Fetal parts | Absent | Present |
| Human chorionic gonadotropin (HCG) level | ↑↑↑ | ↑ |
| Ultrasound findings |
| Reveals fetal parts |
| Malignancy risk | Higher risk for choriocarcinoma | Rare |
Clinical presentation
- Vaginal bleeding
- Uterine enlargement (more than expected for given gestational age)
- Pelvic pressure or pain
- May be associated with
- Early (before 20 weeks) preeclampsia
- Theca-lutein cysts
- Hyperemesis gravidarum
- Hyperthyroidism
Diagnosis
- HCG levels: ↑ serum beta-hCG
- Ultrasound:
- Reveals an irregular distribution of hypoechoic (cystic) and hyperechoic (solid) areas within the uterus
- Characteristically referred to as a “snowstorm“ pattern
Treatment
- Dilation and curettage with methotrexate
- HCG levels are monitored (expected to downtrend after treatment)
- Hysterectomy (last resort)
Hydatid in axial computed tomography (CT) image
Image: “Blasenmole Computertomographie axial” by Hellerhoff. License: CC BY-SA 3.0Choriocarcinoma
Choriocarcinoma is a highly aggressive malignant neoplasm of trophoblastic cells that can develop during or after pregnancy in the mother or baby.
Etiology
Can be preceded by:
- Hydatidiform mole (50%)
- Abortion of an ectopic pregnancy (20%)
- Normal-term pregnancy (30%)
Clinical presentation
- Abnormal uterine bleeding or amenorrhea
- If hematogenous spread to the lungs: shortness of breath and/or hemoptysis
Diagnosis
- HCG levels: ↑ serum beta-hCG
- Pelvic ultrasound: hypervascularity
- Chest X-ray: pulmonary metastases with “cannonball” shape
Treatment
- Depends on stage and risk classification
- Low risk: methotrexate monotherapy or combination with actinomycin D
- High risk: multi-agent regimen
- Etoposide
- Methotrexate (MTX)
- Actinomycin D
- Leucovorin calcium
- Cyclophosphamide
- Vincristine
Clinical Relevance
Ectopic pregnancy: Eccyesis or ectopic pregnancy refers to the implantation of the blastocyst outside the uterine cavity. The most common site is the fallopian tube. Affected patients suffer from acute abdominal pain. Diagnosis is by ultrasound and laboratory analysis, which confirms pregnancy with implantation outside the uterus.
