MyMedR

Clinicopathologic and immunohistochemical differences in complete and partial hydatidiform moles in a multiracial Malaysian population

Hayati AR, Tan GC

Int J Gynecol Pathol, 2005 Jul;24(3):277-85.

PMID: 15968205

Matched MeSH terms: Hydatidiform Mole/metabolism*; Hydatidiform Mole/pathology*

Management of gestational trophoblastic disease in developing countries

Sivanesaratnam V

Best Pract Res Clin Obstet Gynaecol, 2003 Dec;17(6):925-42.

PMID: 14614890 DOI: 10.1016/S1521-6934(03)00097-X

In Malaysia, the incidence of molar pregnancy and gestational trophoblastic neoplasia is 2.8 and 1.59 per 1000 deliveries, respectively; the disease is more common among the Chinese compared to the Malays and Indians. While uterine suction is the preferred method of uterine evacuation of hydatidiform mole, complete evacuation was not achieved at the first attempt in 25% of cases. Partial moles comprise 30% of all moles; these need follow up similar to that for complete moles as they are potentially malignant. In the management of invasive moles, chemotherapy should not be withheld in the presence of metastases or failure of regression of hCG. Placental site tumours are rare. Prophylactic hysterectomy and prophylactic chemotherapy are not recommended. However, in those patients with unsatisfactory hCG regression curves indicating 'at risk' in developing gestational trophoblastic neoplasia (GTN), 'selective preventive chemotherapy' appears appropriate. Chemotherapy remains the main modality of treatment for GTN. As tumour bulk and location of disease are important determinants in outcome, we categorized our patients into low, medium- and high-risk groups with survivals of 100, 98 and 61.7% respectively. Surgery and radiotherapy have a limited role.

Matched MeSH terms: Hydatidiform Mole, Invasive/therapy; Hydatidiform Mole/surgery

Dermatoglyphic patterns on fingers and gynecological cancers

Abbasi S, Rasouli M

Eur J Obstet Gynecol Reprod Biol, 2018 Mar;222:39-44.

PMID: 29353131 DOI: 10.1016/j.ejogrb.2017.10.020

OBJECTIVES: Fingerprints have so far been used for determining the basis of certain malignant diseases, with positive outcomes. Considering the high rates of cancer-related mortality in Iran, this study was conducted for the purpose of examining the dermatoglyphic pattern of fingers in patients with gynecological cancers as compared to healthy people.

STUDY DESIGN: The present study was conducted on 151 women with gynecological cancers as the case group and 152 healthy women with no history of such cancers as control group. The dematographic details of participants from both control and case groups were collected using a checklist, and the pattern of their fingerprints was prepared and examined. The data were analyzed for their significance using chi-square test and t- test. Odds ratio with 95% confidence intervals were calculated.

RESULTS: Dermatoglyphic analysis showed that arch and loop patterns significantly changed in cases group as compared to control. However, the odds ratio suggested that loop pattern in 6 or more fingers might be a risk factor for developing gynecological cancers.

CONCLUSION: Our results showed that there is an association between fingerprint patterns and gynecological cancers and so, dermatoglyphic analysis may aid in the early diagnosis of these cancers.

Matched MeSH terms: Hydatidiform Mole/diagnosis; Hydatidiform Mole/ethnology; Hydatidiform Mole/epidemiology

Complete mole with a coexistent normal fetus: a case report

Rahman RA, Ahmad S, Ismail NA, Mahdy ZA

J Reprod Med, 2012 Sep-Oct;57(9-10):456-8.

PMID: 23091998

The incidence of a coexistent normal fetus is quoted in literature as 1 in 22,000 to 100,000 pregnancies and may be associated with multiple complications including persistent trophoblastic neoplasia.

Matched MeSH terms: Hydatidiform Mole/diagnosis*

Outcome of molar pregnancies in Malaysia: a tertiary centre experience

Nirmala CK, Nor Azlin MI, Harry SR, Lim PS, Shafiee MN, Nur Azurah AG, et al.

J Obstet Gynaecol, 2013 Feb;33(2):191-3.

PMID: 23445147 DOI: 10.3109/01443615.2012.741150

Gestational trophoblastic disease (GTD) is a common problem among Asian ethnics. A total of 102 women with molar pregnancies between 1 January 2005 and 31 December 2010, were analysed. The aim of the study was to determine the outcome of all molar pregnancies in our institution. The local incidence of molar pregnancy was 2.6 per 1,000 deliveries. A total of 48 women (47.1%) had complete hydatidiform mole and another 54 (52.9%) had partial mole. The mean age of the women with molar pregnancies was 32.0 ± 7.9 years. The mean gestational age at initial diagnosis was 11 weeks ± 3 days. The majority (97 women, 95.1%) had symptoms of vaginal bleeding and 18 (17.6%) women had a uterus larger than dates. A total of 48 (47.1%) women had ultrasound scan findings of 'snow-storm' appearance. None of the women with uncomplicated molar pregnancy had evidence of relapse following one undetectable serum β-hCG level. Four out of the 102 women (3.9%) developed persistent trophoblastic disease before attaining one undetectable serum β-hCG level. All four women required single agent methotrexate and they remained in remission. The prognosis for uncomplicated molar pregnancy is good. Establishment of a National Trophoblastic Centre is recommended to maintain optimal outcome.

Matched MeSH terms: Hydatidiform Mole/epidemiology*

Fulltext A cervical ectopic masquerading as a molar pregnancy

Masir N, Tamby MR, Jamil MA

Med J Malaysia, 2000 Mar;55(1):138-40.

PMID: 11072500

We report a case of cervical pregnancy complicated by life threatening hemorrhage. An initial diagnosis of molar pregnancy was made preoperatively. During uterine evacuation she developed profuse hemorrhage which required an emergency hysterectomy for uncontrolled bleeding. Histopathological examination confirmed a cervical pregnancy. The clinical and pathological criteria for the diagnosis and the etiology of cervical pregnancy are discussed.

Matched MeSH terms: Hydatidiform Mole/diagnosis*

Extra-amniotic prostaglandin E2 and intravenous oxytocin in termination of mid-trimester pregnancy and the management of missed abortion and hydatiform mole

Arshat H

Med J Malaysia, 1977 Mar;31(3):220-5.

PMID: 904515

Matched MeSH terms: Hydatidiform Mole/drug therapy*

Fulltext Clinical observations of hydatidiform moles in a Malaysian hospital

Ong HC, Lee PYA, Ng TK, Chong CH

Singapore Med J, 1978 Mar;19(1):33-6.

PMID: 663681

A retrospective analysis of 102 cases of hydatidiform moles seen in the Maternity Hospital, Kuala Lumpur, Malaysia, is presented. The incidence was 1 : 669. The tumour was more common In the Malays and in the lower social class patients. No specific age group or parity group was exempted. Vaginal bleeding and amenorrhoea were prominent features. Hyperemesis and abdominal cramps occurred less commonly. The uterine size was larger than dates in 62.7% of patients. Pre-eclampsia complicated 23.5% of the moles and Its severity was inversely related to the uterine size. Spontaneous abortion occurred In 57.8% of patients at a mean gestational period of 19 weeks.

Study site: Maternity Hospital Kuala
Lumpur, Malaysia

Matched MeSH terms: Hydatidiform Mole/epidemiology*

Inter-observer variability in the histologic criteria of diagnosis of hydatidiform moles

Sarmadi S, Izadi-Mood N, Sanii S, Motevalli D

Malays J Pathol, 2019 Apr;41(1):15-24.

PMID: 31025633

INTRODUCTION: In the event of encountering hydropic villi in products of conception specimens, pathologists will have to distinguish complete and partial hydatidiform mole (CHM & PHM) from hydropic abortion (HA). The histological diagnostic criteria are subjective and demonstrate considerable inter-observer variability.

MATERIALS AND METHODS: This study evaluated the inter-observer variability in diagnosis of CHM, PHM and HA according to defined histologic criteria. Ninety abortus conception specimens were reviewed. Representative haematoxylin and eosin-stained slides were assigned independently to two pathologists who were asked to make a diagnosis of CHM, PHM or HA, and provide a report of the identified diagnostic histological criteria. Kappa value was calculated for the inter-observer agreement.

RESULTS: There was a total of 36.7% disagreement between two pathologists (K = 0.403, Strength of Agreement = moderate), of which 24.4% and 12.2%, were differentiating PHM from CHM and PHM from HA, respectively. Among defined diagnostic histological criteria, the highest rate of agreement was observed in the identification of cistern formation and hydropic changes (K = 0.746 and 0.686 respectively, Strength of Agreement = substantial).

CONCLUSION: There was moderate to substantial agreement rate between two pathologists in identification of two essential histologic criteria for diagnosis of molar pregnancies i.e. "hydropic change" and "trophoblastic proliferation".

Matched MeSH terms: Hydatidiform Mole

Termination of pregnancy in cases of intrauterine fetal death, missed abortion, molar and anencephalic pregnancy with intramuscular administration of 2a 2b dihomo 15(S) 15 methyl PGF2 alpha methyl ester--a multicentre study

Karim SM, Ratnam SS, Hutabarat H, Hanafiah J, Simanjuntak P, Teoh SK, et al.

Ann Acad Med Singap, 1982 Oct;11(4):508-12.

PMID: 7165272

2a 2b dihomo 15(S) 15 methyl PGF2 alpha methyl ester (dihomo 15 me PGF2 alpha) in intramuscular doses of 0.5 mg 8 hourly was used in 631 patients with abnormal intrauterine pregnancy comprising 282 cases of intrauterine fetal death, 233 cases of missed abortion, 34 and 82 cases respectively anencephalic and molar pregnancies. The study was carried out as a collaborative project between the University Departments of Obstetrics and Gynaecology in Singapore (Singapore), Medan (Indonesia) and Kuala Lumpur (Malaysia) during the period June 1974 and November 1979. Six hundred patients (95.1%) aborted or delivered in a mean time of 11.3 hours (S.D. +/- 7.0) with an average of 1.8 injections of the prostaglandin analogue per patient. Side effects included vomiting (23.6%; mean 0.45 episodes per patient), diarrhoea (44.4%; mean 1.00 episode per patient), cold and shivering (11.9%) and pyrexia (12.4%). One patient sustained a cervical laceration which did not require repair. There were no complications.

Matched MeSH terms: Hydatidiform Mole/therapy*

TROPHOBLASTIC TUMORS; GEOGRAPHICAL VARIATIONS IN INCIDENCE AND POSSIBLE AETIOLOGICAL FACTORS

LLEWELLYN-JONES D

J Obstet Gynaecol Br Commonw, 1965 Apr;72:242-8.

PMID: 14273103

Matched MeSH terms: Hydatidiform Mole*

Fulltext Choriocarcinoma after Caesarean Section – Repeated Misgivings

Roszaman, R., Ghazali Ismail

International Medical Journal Malaysia, 2006;5(1):1-4.

MyJurnal

Choriocarcinoma is a malignant proliferation of syncytial trophoblast cells that do not form placental villi. It is a relatively rare and highly malignant variant of gestational trophoblastic disease. Although choriocarcinoma is mostly observed after a molar pregnancy, it may be preceded by any gestational event. It has been shown that even a partial mole can transform into choricarcinoma. Incidence rates of choriocarcinoma differ widely throughout the world. In Europe and North America, choriocarcinoma is reported to affect one in every 30,000 to 40,000 pregnancies, and one in 40 molar pregnancies. In South East Asia, choriocarcinoma is reported to affect one in every 500-3000 pregnancies. Following livebirth, choriocarcinoma with metastatic disease are important sequele (31%)(Tidy et al 1995). In the same study the reported median interval between antecedent pregnancy and choriocarcinoma is five months. Multi agent chemotherapy is required in the majority of patients (82%) for the high risk group. The prognosis for choriocarcinoma after a normal gestation is poorer. The mortality rate is also significantly higher than non-molar abortion (21%). Effective treatment with oral Methotrexate in metastatic choriocarcinoma to the lung confirmed the highly sensitive nature of this tumour to chemotherapy agent.

Matched MeSH terms: Hydatidiform Mole

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