Question
A pregnant woman at 12 weeks of gestation presented with Vaginal Bleeding and Hyperemesis.
On physical examination,a uterine enlargement greater than expected for gestational age and Preeclampsia is present.
USG of this patient shows the following appearance.What can be the most probable diagnosis?
A. Ectopic Pregnancy
B. Complete Hydatidiform Mole
C. Choriocarcinoma
D. Partial Hydatidiform Mole
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Correct Answer » B Explanation |
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Ans:B. Complete Hydatidiform Mole
USG shows Bunch of grapes appearance with no fetal structures seen in Complete Hydatidiform mole.
Gestational trophoblastic neoplasia
- It encompasses several disease processes that originate in the placenta,that occur after abnormal fertilization.
- GTN includes complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), invasive mole, choriocarcinoma, and placental-site trophoblastic tumor (PSTT).
- CHM and PHM together account for 80% of all cases of GTN.
Pathology
- Complete moles are associated with the absence of a fetus and partial moles usually occur with an abnormal fetus or may even be associated with fetal demise.
Chromosomal composition
- Ninety percent of complete hydatidiform moles have a 46XX diploid chromosomal pattern. All the chromosomes are derived from a single sperm in 90% or less likely two sperms, suggesting fertilization of a single egg that has lost its chromosomes.
- With partial moles, the karyotype is usually triploid (69XXY): the result of fertilization of a normal egg by two sperm, one bearing a 23X chromosomal pattern and the other a 23Y chromosomal pattern.
Location
- Complete hydatidiform moles usually occupy the uterine cavity and are rarely located in fallopian tubes or ovaries.
Clinical Features:
Complete mole:
- Vaginal bleeding , Hyperemesis
- Hyperthyroidism may be present due to stimulation of the thyroid gland by the high levels of circulating hCG.
- Partial mole:. These patients usually present with signs and symptoms consistent with an incomplete or missed abortion, including vaginal bleeding and absence of fetal heart tones.
Physical examination:
- A uterine enlargement greater than expected for gestational age is a classic sign of a complete mole.
- Preeclampsia
Markers
- In the classic case of molar pregnancy, quantitative analysis of beta-HCG shows hormone levels in both blood and urine greatly exceeding those produced in a normal pregnancy at the same stage.
- hCG levels greater than 100,000 mIU/mL indicate exuberant trophoblastic growth and raise suspicion for a molar pregnancy
Radiographic features
- Ultrasonography is the imaging investigation of choice to confirm the diagnosis of hydatidiform mole.
- Complete hydatidiform mole
- Enlarged uterus
- Solid collection of echoes with numerous small (3-10 mm 6) anechoic spaces (snowstorm or granular appearance).
- The molar tissue demonstrates the bunch of grapes sign which represents hydropic swelling of trophoblastic villi.
- Normal interface between abnormal trophoblastic tissue and myometrium.
- No identifiable fetal tissue or gestational sac is seen.
Partial mole
- Placenta is enlarged and contains areas of multiple, diffuse anechoic lesions
- A fetus with severe structural abnormalities or growth restriction, oligohydramnios or a deformed gestational sac may be noted.
Treatment:
- Evacuation of the uterus by dilation and curettage
