The authors analyzed ultrasonographic findings of 112 cases of trophoblastic disases which were confirmed byD&E or hysterectomy at Wallace Memorial Baptist Hospital from September 1980 to December 1984. The results were asfollows; 1. Of all 112 cases, hydatidiform moles were 99 cases, invasive moles were 3 cases and choriocarcinomas were 10 cases. 2. 81 cases (72%) occurred in 3rd decades. 3. The sized of uterus was large for gestational weeksin 65 cases(56%) and smaller in 13 cases(13%). 4. The contour of uterus was globular in 59 cases(53%), diffuse in49 cases(44%) and nodular in 4 cases(3%). 5. The internal echopatterns of uterus revealed numerous small vesicular snowstorm patterns in all cases, and revealed internal degeneration in 67 cases(60%). 6. Uterine walls in 89 cases(79%) were well delineated but uterine walls in 23 cases(21%) were poor delineated. 7. Multiseptated ovarian thecalutein cysts were seen in 36 cases (32%). 8. Invasive trophoblastic disease(invasive moles 3 cases andchoriocarcinomas 10 cases) revealed similiar ultrasonographic findings with H-mole, but more irregular internalechoes and irregular echoes in uterine wall. 9. Diagnostic accuracy was diagnostic in 98 cases (88%) , nonspecificin 11 cases (10%) and error in 3 cases(2%).
Choriocarcinoma ; Female ; Hydatidiform Mole ; Hydatidiform Mole, Invasive ; Hysterectomy ; Pregnancy ; Protestantism ; Trophoblasts ; Uterus

Sad fetus syndrome is a rare gestational trophoblastic disease wherein a hydatidiform mole coexists with a live fetus. We report a case of a 40‑year‑old G4P2 (2012) with 29 weeks gestational age who came in with vaginal bleeding and labor pains. A previous ultrasound done at 16 weeks of gestation showed a live fetus, a normal placenta, and a focal multicystic uterine mass. The beta‑human chorionic gonadotropin level was 1,500,000 mIU/mL. She delivered a live preterm female fetus weighing 900 g by partial breech extraction. The placenta was grossly normal. Postpartum hemorrhage secondary to uterine atony was encountered and a total hysterectomy with bilateral salpingectomy was performed. Cut section of the specimen revealed molar tissue at the anterofundal area with evidence of gross myometrial invasion. The histopathologic finding was consistent with a diagnosis of partial hydatidiform mole. This paper describes the incidence, pathology, clinical presentation, diagnosis, treatment, and postpartum course of this rare condition.
Hydatidiform Mole

social resistance ; Chemotherapy-Oncologic Procedure ; Singular ; Etoposide ; Hydatidiform Mole, Invasive

Invasive mole is a malignant form of hydatidiform mole and can be seen occasionally. It invades the myometrium, adjacent structures and metastasizes distantly. It can initially appear with symptoms of the respiratory, genitourinary system, or rarely intraperitoneal hemorrhage. However, reports of invasive mole initially presenting symptom of brain metastasis is rare and is occasionally found at autopsy. We report a case of invasive mole which had metastasized to the brain and lung and initially presented with symptoms of brain metastasis.
Animals ; Autopsy ; Brain* ; Female ; Hemorrhage ; Hydatidiform Mole ; Hydatidiform Mole, Invasive* ; Lung ; Mice ; Myometrium ; Neoplasm Metastasis* ; Pregnancy ; Urogenital System

Background: During postmolar evacuation surveillance, beta-human chorionic gonadotropin (β-hCG) regression levels can predict invasive disease while Doppler ultrasound can assess in vivo tumor neovascularization and quantify uterine blood supply. As an ancillary tool to β-hCG monitoring, ultrasound can detect the early presence of viable trophoblastic tissues and identify patients at risk of developing postmolar gestational trophoblastic Neoplasia (PMGTN). Objective: The objective of this study was to correlate uterine artery Doppler ultrasound with β-hCG levels during pre- and postmolar evacuation surveillance among patients with complete mole. Materials and Methods: A cohort of patients with sonographic diagnosis of complete hydatidiform mole and managed with suction curettage in the same institution were prospectively followed up after evacuation. The pre- and postmolar evacuation surveillance period was at days 1, 7, 14, 21, 28, and 35. Monitoring of serum β-hCG levels was based on the standard regression curve. For Doppler ultrasound parameters, monitoring of the systolic/diastolic (S/D) ratio, pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) was based on its relationship with its serum β-hCG levels. The ultrasound images generated were archived and reviewed by the authors. Descriptive and inferential statistics were utilized to analyze median differences. For the correlation of uterine artery Doppler flow parameters, analysis for the test of difference used Pearson correlation and multiple linear regression analysis for the odds ratio. Results: Sixteen of the 23 enrolled patients completed the protocol (16 of 23, 69.50%). A majority had spontaneous remission (13; 81%) while 3 cases (19%) presented increasing and plateauing β-hCG levels. The pre- and post evacuation median β-hCG levels showed a significant decrease (P = 0.001). As post evacuation β-hCG levels decreased, PSV also decreased (r = 0.478, P = 0.061) while Doppler parameters, RI, PI, and S/D ratio increased. However, when post evacuation β-hCG levels rose or plateaued, Doppler parameters decreased. These changes had statistical correlation (all P < 0.05). Moreover, the magnitude of the relationship for β-hCG and Doppler parameters was moderate and ranged from 0.524 to 0.581. Among the Doppler parameters, the S/D ratio and RI of the right uterine artery strongly predicted a rise in β-hCG levels. The odds ratio of predicting increased β-hCG levels and risk of gestational trophoblastic neoplasia by the right S/D ratio were − 2683.67 (confidence interval [CI] = −271.692–5095.655; P = 0.034) and by the right RI − 66,193.34 (CI = −161,818.107–29,431.433; P = 0.046). Notably, Doppler parameter changes appeared early at day 14 up to day 35 and before the appearance of abnormal β-hCG regression patterns. Conclusion There is a strong correlation between uterine artery Doppler flow changes and β-hCG levels during postmolar evacuation surveillance. The inverse relationship of the S/D ratio, PI and RI, and β-hCG regression patterns confirms spontaneous remission of the disease. For patients with abnormal β-hCG patterns, this relationship is altered. The Doppler changes become erratic, unpredictable, and significantly decreased. These changes were detected as early as 2 weeks post evacuation. Thus, the use of ultrasound as an adjunct to β-hCG post evacuation surveillance can predict abnormal β-hCG regression patterns and identify patients at risk of developing postmolar gestational trophoblastic neoplasia (PMGTN).
Hydatidiform Mole ; Gestational Trophoblastic Disease ; Hydatidiform Mole

No abstract available.
Female ; Hydatidiform Mole* ; Pregnancy

54 cases of hydatidiform mole pregnancy were studied at the Department of Gynecology and Obsterics of the Central Hospital from June 2000 to July 2001, in comparing with 124 cases of normal immature delivery of living neonate. A high rate of clinical symptoms were noted including vaginal hemorrhage in the first trimester, a more unterine height than in normal fetal age, anemia, severe vomit, pre-eclampsia, hyperthyroidism, luteino-adenoma cyst of > 5 cm diametre. There is a positive relation between vaginal bleeding, uterine height before the curettage and the state of luteino adenoma cyst with Chorio complication. Related factors of hydatidiform mole pregnancy were nutritional status, occupation, age, history of abortment and water source hygiene.
Diagnosis ; Hydatidiform Mole ; Pregnancy

The co-existence of a hydatidiform mole with a living fetus during the third trimester is extremely rare. The optimal management of such a case is controversial especially when medical and obstetric complications set in before term. The aim of management is towards avoidance of complications and planning the delivery at the most appropriate time to ensure good maternal and fetal outcome. We report the case of a 27-year-old Gravida 2 Para 1, who was diagnosed with a complete mole with co-existing live fetus at around 12 weeks age of gestation. She was referred to our institution at 31 weeks and 1 day age of gestation due to vaginal bleeding for which an emergency cesarean section was done. She delivered a live baby boy weighing 1.5 kg, with Apgar Score of 4,6,6. Chemoprophylaxis was administered and her serum beta human chorionic gonadotropin was monitored post-partum.
Pregnancy ; Female ; Hydatidiform Mole

Hydatidiform mole coexistent with a live fetus (CMCF) is a rare entity occurring in 1:20,000 to 1:100,000 pregnancies. Three mechanisms of this type are possible: (1) a singleton pregnancy consisting of partial mole with a triploid fetus, (2) a twin gestation consisting of an androgenic complete hydatidiform mole with a biparental diploid fetus, and (3) a twin gestation consisting of a biparental diploid fetus with a normal placenta and a partial hydatidiform mole (PHM) with a triploid fetus. The abnormal triploid fetus in a partial mole tends to die in the first trimester while the fetus coexisting with a complete or partial mole in the dizygotic twin pregnancy has a chance to survive. Early detection and diagnosis of a molar gestation with a viable fetus is needed to allow medical interventions, if available. Three cases of complete mole with a twin fetus (CMTF) that were diagnosed in the prenatal period by ultrasonography will be presented. This report will also discuss the indications for continuing the pregnancy, and review the literature on the recommended prenatal care, intrapartum management, and postpartum surveillance. This report aims to encourage others to document cases of CMTF in order to arrive at a consensus regarding its optimal management.
Hydatidiform Mole ; Pregnancy, Twin

For the clinical analysis and evaluation on the patients with gestational trophoblastic disease(GTD), a study was done retrospectively on 114 patients with GTD(60 in Hydatidiform mole, 10 in invasive mole, 44 in choriocarcinoma) treated from Jan. 1, 1985 to Dec. 31, 1994 at the Department of Obstetrics and Gynecology, Kosin Medical College, Pusan, Korea. We obtained the following results ; The incidence of GTD was 1 per 73 deliveries in H. mole, 1 per 437 deliveries in invasive mole, and 1 per 99 deliveries in choriocarcinoma. The most prevalent age was 21-40 groups. Abnormal vaginal bleeding was a main symptom and sign. 30.6% of H. mole was managed by dilatation and curettage. 90.0% of invasive mole and 51.4% of choriocarcinoma were managed by surgical treatment and chemotherapy. The overall remissinon rate of choriocarcinoma was 71.4%(100.0% in stage I, 66.7% in stage II, 54.5% in stage III, 50.0% in stage IV).
Busan ; Choriocarcinoma ; Dilatation and Curettage ; Drug Therapy ; Female ; Gestational Trophoblastic Disease* ; Gynecology ; Humans ; Hydatidiform Mole ; Hydatidiform Mole, Invasive ; Incidence ; Korea ; Obstetrics ; Pregnancy ; Retrospective Studies ; Trophoblasts ; Uterine Hemorrhage