Hydatidiform Mole

00:01 Our next topic is hydatidiform mole.

00:05 What exactly is the mole? And what are we referring to? Or big picture? Our section here is placental pathologies.

00:14 That’s exactly what’s going on.

00:15 It’s the placenta that is going to then – Well, let me show you different characteristics.

00:21 We’ll take a look at partial and complete mole.

00:24 The mole refers to the fact of how much of the placenta is being affected and whether or not you’ll actually find fetal remnants within the placenta.

00:36 Presents in fourth to fifth month of pregnancy, so relatively early in pregnancy.

00:43 There’d be vaginal bleeding in both partial and complete as we shall see.

00:48 Uterus that is larger than expected for duration of pregnancy.

00:51 The gestational age in which you would expect full uterine size size is much, much greater in hydatidiform mole.

00:58 This particular picture that you’re seeing here would be that in which all of the chorionic villi have now become inflamed or dilated.

01:06 All, every single finger-like projection of the chorionic villi, which is part of the placenta, has now become dilated.

01:15 If every single chorionic villi has then become dilated, then you have to call this a complete hydatidiform mole.

01:23 What is the name of the cancer that may then take place of the placenta? That is called choriocarcinoma.

01:31 So there are two types that we’ll take a look at with hydatidiform mole, complete and partial.

01:35 The “C” in complete has a greater risk of going onto “C”, choriocarcinoma.

01:41 Every single chorionic villi has now become dilated.

01:46 What else do you want to keep in mind? The chromosomes.

01:50 So what’s a normal chromosome? Obviously, either 46 XX or 46 XY.

01:57 If it’s a complete mole, you’ll find that there is actually normal chromosomes, 46 XX or 46 XY.

02:04 How is that possible? Hold on for a second.

02:07 Here, because we have such abnormalities of the placenta, you’re going to find extreme, extreme high levels of beta hCG.

02:17 If you were to then take a look at this uterus and placenta, with every single chorionic villi that’s become inflamed -- Well, you might have heard of the term snowstorm appearance.

02:28 That’s exactly what you’d find on your ultrasound, that the dilated chorionic villi looks like a snowstorm upon your ultrasound image.

02:38 Hydatidiform mole, if you take a look at the ultrasound, it looks like a snowstorm.

02:42 I showed you a gross picture and ultrasound.

02:45 Histology might then show you cystic swelling, swelling, swelling of the chorionic villi, especially the complete hydatidiform mole.

02:54 And the complete is the one that has a greater risk of going onto choriocarcinoma.

02:58 In any case, you would find extremely high levels of beta hCG.

03:02 The two different types of moles that we have to know in greater detail.

03:06 Let’s begin.

03:08 Complete mole: Can you tell me a few things about this before we begin? So that you can predict and you get a better idea, reinforcement.

03:14 C – Complete.

03:15 Greater risk of going onto choriocarcinoma.

03:18 C – Complete. What does that mean to you? Every single chorionic villi has now become dilated.

03:22 I’ve now emphasized that over and over again. Why? Why am I making that a big deal? Well, I’ll tell you now.

03:30 Choriocarcinoma, those chorionic villi, they’re absent.

03:34 So you absolutely want to pay attention to description of the chorionic villi.

03:39 If they’re telling you in a stem of a question that every single chorionic villi is inflamed or dilated, that’s a complete mole and take a look at the chromosome, 46 XX.

03:50 “Dr. Raj, that looks perfectly normal.” Yes.

03:53 On appearance, it seems perfectly normal, but that is deceiving, isn’t it? Because you take a look inside the placenta, it’s empty.

04:03 There’s no fetus.

04:04 “So Dr. Raj, how can you have 46 XX and have no fetus?” Because it’s always a man’s fault.

04:09 Always. Know that.

04:11 What do you mean? Well the sperm which is 23 haploid, 23 X or 23 Y.

04:18 It may then double.

04:19 If all that you have is participation of the sperm with no female participation, how in the world are you supposed to have a fetus? You don’t.

04:27 Empty.

04:28 So you have a sperm that will duplicate or dispermy, you’ve heard of.

04:33 That means that two sperms will literally come on and try to fertilize, but that makes no sense either if you don’t have participation of the fetus – excuse me, the female.

04:43 So therefore, you will have 46 XX commonly or maybe perhaps 46 XY.

04:49 However, there are no fetal parts inside the placenta.

04:54 Complete. Take the O in complete.

04:57 Use it to your advantage, for no fetal parts.

05:01 Take the “C” in complete.

05:03 Use that to your advantage, because this will give rise to choriocarcinoma.

05:07 On the other side, we have partial mole.

05:10 You take the “part” in partial and you’ll find parts of the fetus in the placenta.

05:17 So you will actually find parts.

05:19 Now, the description, chromosome Y, this is called triploid.

05:24 What does that mean? Well, instead of 46 XX, it could be something where you have your 69 XXX, 69 XXY.

05:35 Triploid, triploid, triploid.

05:36 Instead of having diploid XX, you have XXY or XXX. You get the point.

05:41 69, 23, 23, 23.

05:44 How is this possible? Well, not only is it the mans fault, but now there’s going to female participation.

05:52 So you’ll have an egg and it will contribute and there will two sperms that will contribute.

05:59 What do you get total? A triploid.

06:02 However, with this type of participation, you’re not going to find a normal fetal development in the placenta.

06:08 So you’ll find fetal parts, fetal parts, that’s huge.

06:12 Once again here, partial mole, you don’t have dilation of every single chorionic villi.

06:17 And the chance of going onto choriocarcinoma, much less than what it is for complete.

06:23 Now that you have a full picture, let’s go onto description.

06:26 Complete mole, can you see as to how quickly now it makes sense? All villi in the complete mole completely are edematous and dilated.

06:36 There’s going to be complete trophoblastic proliferation.

06:39 That’s for complete.

06:41 What about the partial? Some villi edematous and partially surrounded by trophoblastic proliferation.

06:48 Tell me about the fetal content in your placenta.

06:51 Complete - Zip. O. No.

06:53 Partial - Part.

06:56 Complete, no.

06:57 Partial, fetal parts.

06:59 Complete mole, higher risk of choriocarcinoma.

07:02 Partial mole, I’m not saying there isn’t a risk, but there’s a lower risk of choriocarcinoma.