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.