Hm, or molar pregnancy, results from abnormal fertilization of the oocyte egg. Histopathological diagnosis of partial and complete. We removed the tumor by shaving with carbon dioxide laser ablation, and the specimen was sent to the department of pathology for evaluation. Hydatidiform mole hm is a rare mass or growth that forms inside the womb uterus at the beginning of a pregnancy. We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at mbarara regional referral hospital mrrh, mbarara, uganda. Histopathology uterus, corpus, placentahydatidiform mole. The development of mouth sores is most troublesome to adults. Dexamethasone was tapered and stopped in the next 4 days. Birthmarks may appear as moles melanocytic nevi that vary in color from light brown to blue, and are either flat or raised above the surface of the skin.
Gestational trophoblastic disease abbreviated gtd, also gestational trophoblastic neoplasia abbreviated gtn, includes choriocarcinoma and hydatidiform moles. The uterus is larger than the period of amenorrhoea in 50% of cases, corresponds to it in 25% and smaller in 25% with inactive or dead mole. The needle is inserted around the cervix through the opening made in vagina uterine trocar and cannula used during laparoscopy umbilical cord clamp used to clamp the umbilical cord umbilical cord scissors cutting the. It is a type of gestational trophoblastic disease gtd.
Histopathological diagnosis of partial and complete hydatidiform. Lurain, md g estational trophoblastic disease gtd is a spectrum of cellular proliferations arising from the placental villous trophoblast encompassing 4 main clinicopathologic forms. The mole, a collection of sacs cysts containing a jellylike substance. Vesicular mole definition of vesicular mole by the free. Hydatidiform mole with hyperthyroidism perioperative challenges. Since that time, hm also referred to as molar pregnancy or mole has been of clinical and research interest. Hydatidiform moles are divided into complete and partial hydatidiform moles. Request pdf histopathological diagnosis of partial and complete hydatidiform mole in the first trimester of pregnancy the diagnosis of molar pregnancy is. Patients with evidence of marked trophoblastic growth such as preevacuation hcg level of 100,000 miuml, excessive uterine growth 20 week size and theca lutein cysts 6 cm in diameter have 40% incidence of postmolar gestational trophoblastic disease, compared to 4% for those without any of these signs. Contemporary features and clinical implications gestational trophoblastic neoplasia. Vassilakos department of pathology, university medical centre, 1211 geneva 4, switzerland. Of the patients with ultrasound scan diagnosis of molar pregnancy who underwent suction curettage, only 9 69.
Update on the pathology of gestational trophoblastic disease. This was a crosssectional study carried out from november 2016 to february 2017. The incidence is higher toward the beginning and more toward the end of the childbearing period. Hydatidiform mole is a pathologic conceptus characterized by marked enlargement of the placental villi. Vesicular mole definition of vesicular mole by medical. Quiescent gestational trophoblastic disease is a term for that is characterized by persistant,unchanging low levels mole. In the situation in which the hydatidiform mole develops, the embryo is usually either absent or dead. Vesicular mole human reproduction medical specialties. The mass was clinically thought to be a benign tumor, such as an apocrine hidrocystoma. The prognosis for most cases of gtn is characterized by the presence of wide spread of metastasis. Foetal parts and heart sound cannot be detected except in partial mole. Circumferential proliferation of villous trophoblast with villous edema image 2.
The diagnosis of molar pregnancy is a continuing diagnostic problem for many practicing histopathologists who are required to examine specimens of products of conception, particularly since changes in gynecological management in recent years have resulted in uterine evacuation at earlier gestations. Women in their early teenage or perimenopausal years are most at risk. Invasive mole im is common manifestation of gtn characterized by the presence of whole chorionic villi that accompany excessive trophoblastic overgrowth and invasion. Quiescent gestational trophoblastic disease is a term for that is characterized by persistant,unchanging low levels vesicular mole fig. Dec 25, 2014 a presentation about vesicular mole best video ever demonstrating steps to perform a operative hysteroscopy with explanation of the used instruments diagnostic,hysteroscopy,instruments,steps. Hydatidiform vesicular mole it is a benign neoplasm of the chorionic villi. The neonate was morphologically normal and had a normal karyotype.
Hydatidiform mole hm was first described by hippocrates around 400 b. A 25 years old lady, suspected to have miscarriage. The diagnosis of molar pregnancy is a continuing diagnostic problem for many practicing histopathologists who are required to examine specimens of products of conception, particularly since changes. In early complete mole the degree of villous trophoblastic hyperplasia may not be prominent. Chapter 1 introducton histopathology definition it is a branch of pathology which deals with the study of disease in a tissue section. Request pdf histopathological diagnosis of partial and complete hydatidiform mole in the first trimester of pregnancy the diagnosis of molar pregnancy is a continuing diagnostic problem for. Single vesicular papule on the eyelid with atypical. For unknown reasons, the incidence of moles varies by race 9. Breus mole carneous mole a uterine mass that consists of clotted blood and remnants of the placenta and fetal. Definitiona clinical spectrum including all neoplasm derived from abnormal trophoblastic proliferation 3. The major advantages of histopathology are speed, low cost and the ability to provide a presumptive identification of the infecting fungus as well as demonstrating the tissue reaction.
Fig 1 hydatidiform mole, with marked stromal hydropic change. In a complete mole, the chromosomal complement is 46,xx with the genome paternal in origin. Histological comparison of partial hydatidiform mole and. Histopathology remains one of the major tools of diagnosis in mycology20 table 3. The strangestlooking of the family is the starnosed mole, condylura cristata, of northeastern north america, which has a ring of mobile fleshy. A combination of clinical, laboratory and imaging data raises the possibility of molar pregnancy poor interobserver agreement in differentiating between complete mole, incomplete mole and hydropic abortus when using histology alone, with discordance predominantly seen in partial mole vs. Prevalence and factors associated with hydatidiform mole. The histological diagnosis of hydatidiform moles diagnostic. Vesicular mole article about vesicular mole by the free. An incomplete list of things with vesicular nuclei.
Specialist domiatte general hospital gestational trophoblastic disease complete vesicular mole partial vesicular mole invasive mole placentalsite trophoblastic tumor choriocarcinoma definition it is a benign neoplasm of the chorionic villi, characterized by. Circumferential proliferation of trophoblast with cellular atypia image 3. She had done ultrasonography and was diagnosed as vesicular mole, she underwent suction and evacuation procedure since 12 months ago. Among 23 patients, the antecedent pregnancy prior to the diagnosis was fullterm in 12 cases, abortion in 6 cases, hydatidiform mole in 3 cases, and invasive mole in 1 case. The incidence of molar pregnancy varies in different parts of the. Micrcoscopy sections show numerous hydrophic chorionic villi with cistern formation and circumferential trophoblastic proliferation. Hydatidiform mole, in human pregnancy, abnormal growth of the chorion, the outermost vascular membrane that in a normal pregnancy would enclose the embryo and ultimately give rise to the placenta. Propylthiouracil was stopped on the 1 st postoperative day. Contemporary features and clinical implications gestational trophoblastic neoplasia gtn encompasses several entities including. Diagnosis of hydatidiform moles using p57 immunohistochemistry. Hydatidiform moles hm are abnormal conceptions, which occur in about 1 in 500 pregnancies 1. Circumferential proliferation of trophoblast with villous edema.
Mole advanced cases produce characteristic vesicular pattern in early cases cannot differentiate between complete mole and degenerating villi of abortion cystic villi in placenta and increased transverse diameter of gestational sac predict partial mole in one recent study only 34% of moles suspected on ultrasound 58% complete. Histopathological and clinical features of molar pregnancy. Anatomic pathology her2 and p57 in molar pregnancy. May 15, 2010 hydatidiform vesicular mole it is a benign neoplasm of the chorionic villi. Pathological and cytogenetic studies have demonstrated. Hydatidiform moles result from characteristic genetic abnormalities. The tissue undergoes a series of steps before it reaches the examiners desk to be thoroughly examined microscopically to arrive at a particular diagnosis. All patients admitted for uterine evacuation for nonviable. Hydatidiform mole is more common at the extremes of reproductive age. Ultrasound scan shows a snow storm appearance of the uterine content. A molar pregnancy is a gestational trophoblastic disease which grows into a mass in the uterus that has swollen chorionic villi. The histopathology of trophoblastic tumours journal of clinical.
The pathologist utilizes a classification based on histopathology. Marked proliferation of the trophoplast, both the syncytium. The diagnosis is based on histopathology and genetic origin. Request pdf histopathological diagnosis of hydatidiform mole. A skin lesion, commonly a nevus, that is typically raised and discolored. Vesicular mole for undergraduate linkedin slideshare. Feb 16, 2018 hydatidiform mole is a disease of pregnancy and therefore a disease of women. Apr 04, 2012 hydatidiform mole is basically an abnormal conceptus, due to abnormal fertilization which can be subclassified into complete and partial moles based on morphological, pathological, and genetic differences 1, 2. The distinction between partial hydatidiform mole phm and trisomy gestation is not always straightforward histo logically and it is unclear which. Invasive mole follows approximately 1015% of complete hydatiform mole. Interobserver variability in the histologic criteria of diagnosis of. Histopathology uterus, corpus, placenta hydatidiform mole. Apr 11, 2014 a 25 years old lady, suspected to have miscarriage.