MyMedR

A plea against abdominal hysterotomy in the treatment of hydatidiform mole

Chan DP

Med J Malaya, 1965 Sep;20(1):36-8.

PMID: 4221409

Matched MeSH terms: Hydatidiform Mole/surgery*

Hydatidiform mole: problems in early diagnosis

Yusof K

Med J Malaysia, 1973 Jun;27(4):275-9.

PMID: 4270785

Matched MeSH terms: Hydatidiform Mole/complications; Hydatidiform Mole/diagnosis*

Fulltext Complete hydatidiform mole and surviving coexistent twin--a case report

Japaraj RP, Sivalingam N

Singapore Med J, 2000 Mar;41(3):126-8.

PMID: 11063197

Hydatidiform mole with a coexistent fetus is a rare occurrence with an incidence of I per 22,000-100,000 pregnancies. It is associated with persistent gestational trophoblastic tumour. Hence an early and correct diagnosis is imperative to plan subsequent management of such patients. We report a case of a primigravida who presented with vaginal bleeding at early second trimester. Expectant management was carried out for her pregnancy which finally ended in an abortion. The pathology, clinical findings and current management of this rare entity is discussed.

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

Fulltext Molar pregnancy and glomerulonephritis

Teh HS, Halim AG, Soehardy Z, Fauzi AR, Kong CT

Med J Malaysia, 2006 Aug;61(3):361-2.

PMID: 17240591 MyJurnal

A 17-year-old, sexually active, single, nulliparous young woman presented to us with one week history suggestive of nephrotic syndrome. She was found to have a benign hydatidiform mole confirmed by histopathological examination after suction and curettage. Renal biopsy revealed focal segmental glomerulosclerosis. The renal pathology was most probably due to molar pregnancy due to the close temporal relationship. To our knowledge, this is the first case of focal segmental glomerulosclerosis associated with a gestation trophoblastic disease described in the literature.

Matched MeSH terms: Hydatidiform Mole/complications*

Recurrent hydatidiform mole: a report of a patient with 7 consecutive moles

Thavarasah AS, Kanagalingam S

Aust N Z J Obstet Gynaecol, 1988 Aug;28(3):233-5.

PMID: 3233084

A rare case of hydatidiform mole occurring 7 consecutive times in a Chinese woman is presented. She was first seen in 1979 at the age of 23 years, with a molar pregnancy and subsequently had 6 consecutive moles, the last being in July, 1986; at this visit the patient and her husband were very depressed, and convinced that a normal pregnancy was unlikely and requested a hysterectomy. They were warned earlier several times, of the possible long-term consequences of a recurrent mole and that their chance of having a normal baby was very remote. A total hysterectomy was performed at her last presentation as the patient requested one, instead of dilatation and curettage for a persistently high HCG and bulky uterus following suction evacuation. Histology revealed an invasive mole. The beta HCG level was less than 4IU/l by the end of September, 1986 and she is still being followed-up.

Matched MeSH terms: Hydatidiform Mole/diagnosis*

Suction curette evacuation of hydatidiform mole

Kuah KB

Med J Malaya, 1972 Mar;26(3):205-6.

PMID: 5031017

Matched MeSH terms: Hydatidiform Mole/surgery*

Fulltext Perforating invasive mole masquerading as an ovarian tumour--case report

Chandran R, Tham KY, Rose I

Med J Malaysia, 1991 Sep;46(3):255-8.

PMID: 1839922

An invasive mole causing uterine perforation is a rare occurrence. We describe below a case with an unusual presentation which was mistaken for an ovarian tumour. The difficulty in diagnosis and the need for a high index of suspicion is highlighted.

Matched MeSH terms: Hydatidiform Mole/complications*; Hydatidiform Mole/pathology; Hydatidiform Mole/therapy

Fulltext Whole lung tomography in the early detection and follow-up of lung secondaries following hydatidiform mole

Sivanesaratnam V, Singh J

Med J Malaysia, 1985 Dec;40(4):317-20.

PMID: 3842732

22 patients with proven hydatidiform molar pregnancy were subjected to whole lung tomography. By this technique, lung metastases were detected in four patients when plain chest radiographs had shown no secondaries. In a fifth patient additional nodules not observed on the plain radiographs were seen. The usefulness of this procedure as an adjunct to existing methods of following up of patients with metastatic trophoblastic disease is discussed.

Matched MeSH terms: Hydatidiform Mole/pathology; Hydatidiform Mole/radiography; Hydatidiform Mole/secondary*

Complementary role of p57kip2 immunostaining in diagnosing hydatidiform mole subtypes

Zainal N, Kampan NC, Rose IM, Ghazali R, Shafiee MN, Yussoff NH, et al.

Horm Mol Biol Clin Investig, 2021 May 21;42(3):311-316.

PMID: 34018382 DOI: 10.1515/hmbci-2020-0086

OBJECTIVES: Gestational trophoblastic disease comprises of a spectrum of pregnancy-related tumours which includes complete (CHM) and partial hydatidiform moles (PHM). Accurate diagnosis and subclassification of HM subtypes are crucial as prognosis differs. Histopathological examination using haemotoxylin and eosin (H&E) staining remains the basis for diagnosing HM, with only 80% accuracy. p57kip2 is a cyclin-dependent kinase inhibitor (CDKI) protein and is strongly paternally imprinted, being expressed from maternal allele. Therefore, complete mole (CHM) with only paternal genome has nearly absent expression of p57kip2 compared to partial mole (PHM) having both paternal and maternal genomes. This study is aimed to determine usefulness of p57kip2 immunohistochemistry (IHC) analysis in the diagnosis of HM subtypes.

METHODS: A total of 82 archived paraffin embedded HM tissues with subtypes classified based on H&E staining - 39 (47.5%) CHM, 41 (50.0%) PHM and two (2.43%) unclassified molar pregnancy were retrieved. All tissue samples were subjected for p57kip2 IHC analysis and HM subtypes were then reclassified.

RESULTS: A total of 66 cases (80.5%) were re-classified as CHM, 14 cases (17.1%) as PHM and two cases (2.4%) were decidual and cystic tissues. Analysis using p57kip2 immunostaining showed a diagnostic discrepancy of 33.0% from routine H&E staining and helps to improve the characterisation of the HM subtypes specifically at early gestations which have less distinctive morphologies.

CONCLUSIONS: IHC using p57kip2 monoclonal antibody should be considered as a routine ancillary test to H&E in improving the diagnosis of HM subtypes particularly in developing countries with limited resources.

Matched MeSH terms: Hydatidiform Mole/diagnosis*; Hydatidiform Mole/etiology; Hydatidiform Mole/metabolism*

The management of gestational trophoblastic disease in developing countries such as Malaysia

Sivanesaratnam V

Int J Gynaecol Obstet, 1998 Apr;60 Suppl 1:S105-9.

PMID: 9833622 DOI: 10.1016/S0020-7292(98)80012-X

Gestational trophoblastic disease is a common gynaecological problem in Malaysia. The incidence of molar pregnancy is 2.8 per 1000 deliveries, being more common amongst the Chinese. The preferred method of evacuation is suction curettage; complete evacuation of the uterus was not achieved at the first attempt in 25 per cent of cases. Partial moles in our centre comprised 30 per cent of all moles. This is potentially malignant and needs follow-up for a complete mole. In the management of an invasive mole, chemotherapy should not be withheld in the presence of metastases and failure of regression of hCG. The role of prophylactic hysterectomy and prophylactic chemotherapy in the management of molar pregnancy is discussed "Selective preventive chemotherapy" in patients at "risk" appears appropriate. Chemotherapy remains the main modality of treatment for gestational trophoblastic tumours (GTT). We categorised our patients into low, medium and high-risk groups; survivals were 100, 98, and 61.7 percent respectively. These patients when categorised according to FIGO staging had survivals of 100, 80, 78.6 and 68.2 per cent respectively for stages 1, 2, 3 and 4 respectively. The reasons for the poor survival in the 'high-risk' group are discussed. Colour doppler blood flow studies are now being carried out; its role needs further evaluation. Surgery and radiotherapy have only a limited role in the management of these cases.

Matched MeSH terms: Hydatidiform Mole/therapy

Choriocarcinoma--an unusual case

Khoo KE

Med J Malaysia, 1978 Dec;33(2):156-7.

PMID: 755169

Matched MeSH terms: Hydatidiform Mole/complications*

Expression of placental proteins in complete and partial hydatidiform moles

Cheah PL, Looi LM

Pathology, 1994 Apr;26(2):115-8.

PMID: 8090580

Examination of routinely stained haematoxylin and eosin sections may sometimes prove inadequate in differentiating partial hydatidiform moles (PHM) from complete hydatidiform moles (CHM). While cytogenetic analysis can aid in the distinction, such facilities are not always available. The possibility of using immunohistochemistry to aid in the differentiation was studied. Twenty-five histologically proven CHM and 11 PHM were studied for their patterns of expression of human chorionic gonadotrophin (hCG), human placental lactogen (hPL) and placental alkaline phosphatase (PIAP). All CHM stained diffusely with hCG and focally with both hPL and PIAP irrespective of gestational age. Of PHM, 63.6% were diffusely positive for hCG, 27.3% for hPL and 54.5% for PIAP; the rest were focally positive. The hCG pattern changed from diffuse to focal with increasing gestational age of PHM, while those of hPL and PIAP became increasingly diffuse with gestational age. While these protein expressions may be applied in differentiating late PHM from CHM, it is not useful in first trimester cases. The most helpful application is that focal expression of hCG and diffuse expressions of hPL and PIAP is not seen in CHM, thereby excluding such a diagnosis. PHM, in contrast, can show either diffuse or focal expression of all 3 antigens.

Matched MeSH terms: Hydatidiform Mole/diagnosis; Hydatidiform Mole/pathology; Hydatidiform Mole/chemistry*

Fulltext Term delivery of a complete hydatidiform mole with a coexisting living fetus followed by successful treatment of maternal metastatic gestational trophoblastic disease

Peng HH, Huang KG, Chueh HY, Adlan AS, Chang SD, Lee CL

Taiwan J Obstet Gynecol, 2014 Sep;53(3):397-400.

PMID: 25286799 DOI: 10.1016/j.tjog.2013.02.005

OBJECTIVE: A twin pregnancy consisting of a complete hydatidiform mole with a coexisting normal fetus is extremely rare with an incidence of 1/22,000 to 1/100,000. The incidence of preterm delivery is high and few pregnancies reach near term with a viable fetus.
CASE REPORT: A 34-year-old woman presented at 20 weeks of gestation with increased levels of serum beta human chorionic gonadotropin (beta-HCG) at 4.74 multiples of the median (310277.7 mIU/mL). Ultrasonography showed a hydatidiform mole together with a normal fetus. Fetal karyotyping revealed 46XY. The serum beta-HCG levels were followed up throughout the remainder of the pregnancy. A male infant weighting 2260 g and the molar tissue were delivered at 37 weeks of gestation. The karyotype of the molar tissue showed 46XX and the histopathological report confirmed our diagnosis. At 4 months postpartum, metastatic gestational trophoblastic disease of the lung was diagnosed in the mother by a computed tomography scan due to increased beta-HCG levels. The patient received three unsuccessful cycles of methotrexate and folinate. Another four cycles of chemotherapy consisting of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) were initiated and the beta-HCG levels returned to normal. There was no evidence of recurrence in the subsequent 5 years of regular follow up.
CONCLUSION: A pregnancy with a complete hydatidiform mole and a living cotwin can be a serious threat to the health of both the mother and the fetus. Early diagnosis depends on a combination of detecting an unusually high level of serum beta-HCG and ultrasound examination. We suggest that continuation of the pregnancy may be an acceptable option and that the pregnancy may continue until term if a normal fetal anatomy is assured and maternal complications are under control. Patients require careful postpartum follow up and any recurrent disease should be managed aggressively.
KEYWORDS: EMA-CO; metastatic gestational trophoblastic disease; twin pregnancy with one complete hydatidiform mole

Matched MeSH terms: Hydatidiform Mole/drug therapy; Hydatidiform Mole/pathology*

Fulltext Recurrent vomiting in a woman due to miscarriage: think out of the box

Khalid S, Aris MS

BMJ Case Rep, 2016 Mar 30;2016.

PMID: 27030452 DOI: 10.1136/bcr-2015-213165

A 25-year-old gravida 2 para 1 with 12-week amenorrhoea presented a second time for recurrent vomiting in pregnancy. She was diagnosed to have a missed miscarriage following absent fetal heart seen in an early scan. She opted for conservative management. However, on the third presentation, her vomiting continued. Repeated transvaginal ultrasound scan showed a fetus with a crown rump length of 19 mm, which is equivalent to 8 weeks and 4 days, with absence of fetal heart pulsation. Thyroid function tests and β human chorionic gonadotropin were then requested. Results showed that the patient's serum β human chorionic gonadotropin level was markedly raised to 147,000. A molar pregnancy was suspected. Her thyroid function tests came back normal. Suction curettage was performed and histopathology confirmed a partial molar pregnancy. On follow-up, the β human chorionic gonadotropin level was normal by 7 weeks after the curettage.

Matched MeSH terms: Hydatidiform Mole/complications; Hydatidiform Mole/therapy

Fulltext Hydatidiform molar pregnancy in Malaysian women: a histopathological study from the University Hospital, Kuala Lumpur

Cheah PL, Looi LM, Sivanesaratnam V

Malays J Pathol, 1993 Jun;15(1):59-63.

PMID: 8277792

A review of gestational trophoblastic disease diagnosed at the Department of Pathology, University Hospital, Kuala Lumpur from January 1989 to December 1990 using established histological criteria showed 25 complete hydatidiform moles (CHM), 11 partial hydatidiform moles (PHM), 1 invasive mole and 2 choriocarcinoma. The ages of the patients with CHM ranged from 21 to 43 years (mean = 28.5 years) and PHM 20 to 33 years (mean = 27.5 years). The invasive mole occurred in a 42-year-old Malay woman. The two patients with choriocarcinoma were both Chinese and 41 and 46-years old respectively. During the same period, 1,062 non-molar abortions and 13,115 births, inclusive of livebirths and stillbirths were recorded at the University Hospital. The incidence rate of hydatidiform moles was thus estimated to be 1:384 pregnancies. PHM constituted 30% of all molar pregnancies. Hydatidiform moles occurred among the Malays, Chinese and Indians at the rate of 2.43, 2.66 and 3.29 per 1,000 pregnancies respectively. It appears that hydatidiform molar pregnancy has the highest prevalence among the Indians, a finding similar to an earlier Singapore study.

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

ABO blood group in trophoblastic disease

Dawood MY, Teoh ES, Ratnam SS

J Obstet Gynaecol Br Commonw, 1971 Oct;78(10):918-23.

PMID: 5111899

Matched MeSH terms: Hydatidiform Mole/blood*; Hydatidiform Mole/drug therapy

Epidemiology of hydatidiform mole in Singapore

Teoh ES, Dawood MY, Ratnam SS

Am J Obstet Gynecol, 1971 Jun 01;110(3):415-20.

PMID: 5104314

Matched MeSH terms: Hydatidiform Mole/etiology; Hydatidiform Mole/epidemiology*

Incidence of acute atherosis in complete molar pregnancy

Hayati AR, Azizah A, Wahidah A

Malays J Pathol, 1998 Dec;20(2):113-4.

PMID: 10879273

A clinicohistological study of acute atherosis in molar pregnancy was undertaken. Maternal decidual vessels in currettage samples of 38 histologically confirmed complete hydatidiform moles were examined histologically for acute atherosis, recognised as fibrinoid necrosis of the smooth muscle wall with a perivascular mononuclear cell infiltrate, with or without lipophages. Acute atherosis was detected in eight of 38 cases, an incidence of 18.4%. All the patients were normotensive. The significance of acute atherosis in molar pregnancy remains to be clarified.

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

Fulltext Hydatidiform mole and post-evacuation regression patterns of serum beta human chorionic gonadotrophin

Kamariah K, Satgunasingam N, Nasri NM, Ng KY

Med J Malaysia, 1993 Mar;48(1):40-5.

PMID: 7688063

Eighty-nine patients who had hydatidiform moles evacuated at the General Hospital, Kuala Lumpur, were followed with serum beta hCG determinations from October 1988 to June 1991. A regression curve for serum beta hCG, as measured by RIA, was derived from the results of 47 of the patients who demonstrated spontaneous regression of serum beta hCG titres. All 47 patients had normal serum titres at 135 days after evacuation. The mean time taken to reach normal level was 82.6 days, while the range was 39 to 135 days (5 to 19 weeks).

Matched MeSH terms: Hydatidiform Mole/blood*; Hydatidiform Mole/therapy

Fulltext Molar pregnancy with normal viable fetus presenting with severe pre-eclampsia: a case report

Atuk FA, Basuni JBM

J Med Case Rep, 2018 May 21;12(1):140.

PMID: 29779493 DOI: 10.1186/s13256-018-1689-9

BACKGROUND: While gestational trophoblastic disease is not rare, hydatidiform mole with a coexistent live fetus is a very rare condition occurring in 0.005 to 0.01% of all pregnancies. As a result of the rarity of this condition, diagnosis, management, and monitoring will remain challenging especially in places with limited resources and expertise. The case we report is an interesting rare case which presented with well-described complications; only a few similar cases have been described to date.

CASE PRESENTATION: We report a case of a 21-year-old local Sarawakian woman with partial molar pregnancy who presented with severe pre-eclampsia in which the baby was morphologically normal, delivered prematurely, and there was a single large placenta showing molar changes.

CONCLUSION: Even though the incidence of this condition is very rare, recognizing and diagnosing it is very important for patient care and it should be considered and looked for in patients presenting with pre-eclampsia.

Matched MeSH terms: Hydatidiform Mole, Invasive/complications*; Hydatidiform Mole, Invasive/pathology

Displaying publications 1 - 20 of 32 in total