Obstetrics Book

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Hydatidiform Mole

Aka: Hydatidiform Mole, Hydatid Mole, Molar Pregnancy
  1. See Also
    1. Trophoblastic Neoplasia
  2. Epidemiology: Incidence
    1. North America and Europe: 1:1000 to 1:1500 pregnancies
    2. Asia and Latin America: 1:400 to 1:200 pregnancies
    3. Philippines: 1:250
  3. Risk Factors
    1. Prior Molar Pregnancy
    2. Extremes of reproductive age
      1. Age under 20 years
      2. Age over 45 years
    3. Twin Gestation
    4. High parity
    5. Malnutrition
  4. Pathophysiology
    1. Form of Trophoblastic Neoplasia
      1. Benign proliferation of chorionic villi
      2. Fetus absent
    2. Choriocarcinoma (risk: 10-20%) predisposing factors
      1. Complete hydatiform mole
      2. Abnormally proliferative trophoblast
      3. Pitocin or Hysterectomy for mole evacuation
      4. Oral Contraceptive use after mole evacuation
  5. Types
    1. Complete Mole
      1. Total hydatidiform change
      2. Marked proliferation of trophoblastic cells
      3. No evidence of fetal vessels
      4. Karyotype: 46XX (all paternally derived)
        1. Derived from haploid 23X sperm
        2. Sperm duplicates Chromosomes without cell division
      5. Higher risk for malignant change
    2. Partial Mole
      1. Associated with non-viable fetus or vessels only
      2. Moderate trophoblastic proliferation
      3. Karyotype: Triploid (69XXX or 69XXY)
        1. Fertilization by more than one sperm
      4. Malignant change less likely than in complete mole
  6. Symptoms
    1. Vaginal Bleeding during pregnancy in 3rd-4th month
    2. Hyperemesis Gravidarum
    3. Passage of grapelike villi from the Uterus
    4. Abdominal Pain early in pregnancy
    5. Pallor or Dyspnea
      1. Associated with Anemia
    6. Anxiety and Tremor
      1. Due to weak Thyroid stimulation by HCG
  7. Signs
    1. Excessive Uterine enlargement
      1. Larger than expected for Gestational age
    2. Fetus absent
      1. Fetal Heart Tones absent
      2. Absent fetal parts
    3. Ovarian enlargement (10%)
      1. Related to theca-lutein cysts
    4. Onset Hypertension early in pregnancy
      1. Occurs before Pregnancy Induced Hypertension
      2. Occurs in first or second trimester
  8. Histology
    1. Gross Examination
      1. Whitish grape-like cluster
      2. Interspersed blood clots
    2. Microscopic changes of villi
      1. Trophoblastic proliferation
        1. Cytotrophoblast (Langerhans Cell) proliferation
          1. Cuboid cells
          2. Prominent nuclei
        2. Syncytiotrophoblast proliferation
          1. Sheets of cytoplasm proliferate
          2. Dark oval nuclei
      2. Hydropic changes to central stroma
        1. Cystic spaces form (cisterns)
        2. Avascular edematous spaces form
      3. Fetal Vessels absent
  9. Labs
    1. Quantitative bhCG
      1. Excessively elevated above expected levels
      2. Level may exceed 1 Million IU
      3. Directly reflects tumor volume
    2. Complete Blood Count
      1. Anemia
      2. Platelets decreased
    3. Liver Function Testing
    4. Thyroid Function Testing
      1. Thyroid Stimulating Hormone
      2. Free T4
  10. Radiology
    1. Molar Pregnancy screening: Pelvic Ultrasound
      1. Mass of Vesicles appears like snowstorm
      2. Differential diagnosis
        1. Septic Abortion
        2. Fibroma
    2. Molar Pregnancy confirmed
      1. Chest XRay
      2. Consider CT Head and Abdomen
  11. Complications
    1. Malignant transformation to Choriocarcinoma in 10-20%
      1. Locally Invasive Mole: Chorioadenoma destruens (66%)
      2. Gestational Choriocarcinoma (33%)
    2. Hyperthyroidism
    3. Pregnancy Induced Hypertension
  12. Management
    1. Evacuation of Uterus
      1. Dilatation and Evacuation
      2. Dilatation and Curettage
    2. Avoid Hysterectomy, Hysterotomy, or Pitocin
      1. Increased risk of metastasis (Relative Risk: 3.0)
      2. Clamp uterine vessels early if Hysterectomy needed
    3. Chemotherapy Indications after D&C
      1. Quantitative bhCG persistently elevated
      2. Persistent uterine bleeding
      3. Evidence of trophoblastic metastasis
        1. Brain
        2. Lungs
  13. Monitoring
    1. Follow Quantitative bhCG levels until 0
    2. Serial bHCG for 6 months to 1 year
      1. Use Contraception during this time
    3. Chemotherapy if bHCG rises or does not fall to 0
      1. Methotrexate usually used
  14. Prognosis
    1. Recurrence rate of complete mole: 20%
      1. May recur as locally invasive or metastatic
    2. Recurrence rate in future pregnancies: 1-2%
  15. References
    1. Stenchever (2001) Comprehensive Gynecology, p. 1047-62
    2. Shapter (2001) Obstet Gynecol Clin North Am 28(4):805 [PubMed]

Hydatidiform Mole (C0020217)

Definition (NCI) A gestational trophoblastic disorder characterized by marked enlargement of the chorionic villi, hyperplasia of the villous trophoblastic cells and hydropic changes.
Definition (NCI_NCI-GLOSS) A slow-growing tumor that develops from trophoblastic cells (cells that help an embryo attach to the uterus and help form the placenta) after fertilization of an egg by a sperm. A hydatidiform mole contains many cysts (sacs of fluid). It is usually benign (not cancer) but it may spread to nearby tissues (invasive mole). It may also become a malignant tumor called choriocarcinoma. Hydatidiform mole is the most common type of gestational trophoblastic tumor.
Definition (MSH) Trophoblastic hyperplasia associated with normal gestation, or molar pregnancy. It is characterized by the swelling of the CHORIONIC VILLI and elevated human CHORIONIC GONADOTROPIN. Hydatidiform moles or molar pregnancy may be categorized as complete or partial based on their gross morphology, histopathology, and karyotype.
Definition (CSP) trophoblastic hyperplasia associated with normal gestation, or molar pregnancy; characterized by the swelling of the chorionic villi and elevated human chorionic gonadotropin; hydatidiform moles or molar pregnancy may be categorized as complete or partial based on their gross morphology, histopathology, and karyotype.
Concepts Neoplastic Process (T191)
MSH D006828
ICD9 630
ICD10 O01, O01.0, O01.9, M9100/0
SnomedCT 123300001, 48430004, 367455000, 235323008, 156085008, 189856005, 236118006, 198611007, 198610008, 41491009, 44782008, 417044008
LNC LA14685-4
English Hydatidiform Moles, Moles, Hydatidiform, HYDATIDIFORM MOLE, Mole, Hydatidiform, Pregnancy, Molar, Classical hydatidiform mole, Hydatid Mole, Hydatid Moles, Hydatidiform mole, unspecified, Molar Pregnancies, Molar Pregnancy, Mole, Hydatid, Moles, Hydatid, Pregnancies, Molar, MOLAR PREGN, PREGN MOLAR, [M]Hydatidiform mole NOS, Hydatidiform mole NOS, vesicular mole, Mole, NOS, pregnancy vesicular mole, pregnancy vesicular mole (diagnosis), Hydatidiform mole, no ICD-O subtype, molar pregnancy (non-metastatic GTD), vesicular mole in pregnancy, Hydatidiform Mole [Disease/Finding], pregnancy mole, molars pregnancy, hydatidiform moles, mole hydatidiform, mole pregnancy, moles pregnancy, molar pregnancies, molar pregnancy, hydatidiform mole, hydatidiform mole (diagnosis), Molar pregnancy with hydatidiform mole, Mole, Mole (disorder), Hydatidiform mole (disorder), Molar pregnancy with hydatidiform mole (disorder), [M]Hydatidiform mole NOS (morphologic abnormality), Molar pregnancy with vesicular mole (disorder), Hydatidiform mole, no ICD-O subtype (morphologic abnormality), Hydatidiform mole, no International Classification of Diseases for Oncology subtype (morphologic abnormality), Hydatidiform mole, no International Classification of Diseases for Oncology subtype, Hydatid mole, Hydatidiform mole, Molar pregnancy, Molar pregnancy (disorder), Mole of pregnancy, GTT, hydatidiform mole, chorionic tumor, gestational trophoblastic tumor, hydatidiform mole, hydatid mole, hydatidiform mole GTT, classical; hydatidiform mole, hydatidiform mole; classical, hydatidiform; mole, molar pregnancy; pregnancy, mole; hydatidiform, classical, mole; hydatidiform, mole; pregnancy, hydatidiform, mole; vesicular, pregnancy; hydatidiform mole, pregnancy; mole, hydatidiform, pregnancy; mole, vesicular; mole, Molar pregnancy, NOS, Mole of pregnancy, NOS, Hydatidiform mole, NOS, Hydatidiform mole [Ambiguous], Molar pregnancy with hydatidiform mole (disorder) [Ambiguous], Mole -RETIRED-, Hydatidiform Mole, Vesicular mole, Molar pregnancy with hydatid mole, Molar pregnancy with vesicular mole, Hydatidiform mole (morphologic abnormality)
French MOLE HYDATIFORME, Grossesse molaire, Môle hydatiforme SAI, Môle vésiculaire, Môle hydatiforme, Grossesse môlaire
Portuguese MOLA HIDATIFORME, Gravidez molar, Mole hidatiforme, Mole hidatiforme NE, Gravidez Molar, Mola Hidatiforme
Spanish MOLA HIDATIFORME, Embarazo molar, Mola hidatiforme NEOM, Mola hidatiforme, mola hidatiforme (anomalía morfológica), mola hidatiforme, no clasificada como subtipo en CIE-O (anomalía morfológica), mola hidatiforme, sin subtipo CIE-O (anomalía morfológica), mola hidatiforme, no clasificada como subtipo en CIE-O, mola hidatiforme, sin subtipo CIE-O, mola - RETIRADO -, embarazo molar con mola hidatídica, embarazo molar con mola vesicular (trastorno), [M]mola hidatiforme, SAI, mola hidatídica, mola - RETIRADO - (concepto no activo), mola hidatídica (trastorno), embarazo molar con mola hidatiforme (trastorno), embarazo molar con mola hidatiforme, [M]mola hidatiforme, SAI (anomalía morfológica), embarazo molar con mola vesicular, embarazo molar (trastorno), embarazo molar con mola hidatiforme (concepto no activo), embarazo molar, mola del embarazo, mola hidatiforme, Embarazo Molar, Mola Hidatiforme
German BLASENMOLE, Hydatidenmole, hydatidiforme Mole NNB, Blasenmole, nicht naeher bezeichnet, Klassische Blasenmole, Blasenmole, Molenschwangerschaft, Schwangerschaft, Molen-
Dutch hydatidiforme mola NAO, molazwangerschap, hydatidiforme mola, hydatidiforme mola; klassiek, hydatidosa; mola, klassiek; hydatidiforme mola, mola; hydatidosa, klassiek, mola; hydatidosa, mola; vesiculair, mola; zwangerschap, hydatidosa, molazwangerschap; niet-hydatiform, vesiculair; mola, zwangerschap; hydatidiforme mola, zwangerschap; mola, hydatidosa, zwangerschap; mola, Klassieke mola hydatidosa, Mola hydatidosa, niet gespecificeerd, Mola hydatidosa, Molazwangerschap, Zwangerschap, mola-
Italian Mola idatiforme NAS, Mola vescicolare, Gravidanza molare, Mola idatiforme
Japanese 奇胎妊娠, 胞状奇胎NOS, ホウジョウキタイNOS, ホウジョウキタイ, キタイニンシン, 奇胎, 胞状奇胎
Swedish Hydatidmola
Czech mola hydatidosa, Molární těhotenství, Hydatidiformní mola, Mola hydatidosa NOS, molární těhotenství
Finnish Rypäleraskaus
Russian PUZYRNYI ZANOS, ПУЗЫРНЫЙ ЗАНОС
Korean 상세불명의 포상기태, 포상기태, 고전적 포상기태
Croatian MOLA HIDATIDOZA
Polish Zaśniad groniasty
Hungarian Mola hydatidosa, Mola terhesség, Mola hydatidosa k.m.n.
Norwegian Blæremola, Hydatidmola
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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