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Warton EM, Dickinson JE, White SW, Leung Y, Berry B. Complete hydatidiform mole with concurrent fetus: Two cases of live, term birth coupled with spontaneous resolution of molar tissue. Australas J Ultrasound Med 2024; 27:65-70. [PMID: 38434545 PMCID: PMC10902830 DOI: 10.1002/ajum.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Pregnancies with a complete hydatidiform mole and co-existing fetus (CMCF) are rare, but increasingly common due to the rising prevalence of assisted reproductive technology. They are frequently associated with adverse obstetric outcomes, providing women with the challenge of pregnancy termination or continuing the pregnancy at the risk of maternal-fetal morbidity and fetal mortality. This report demonstrates two cases of CMCF pregnancy with excellent maternal-fetal outcomes, including spontaneous resolution of the molar tissue antenatally. It is helpful in counselling women who are diagnosed with this rare and frequently morbid condition in considering how to proceed with their pregnancy.
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Affiliation(s)
- Emily M. Warton
- Department of Obstetrics and GynecologyKing Edward Memorial HospitalPerthWestern AustraliaAustralia
| | - Jan E. Dickinson
- Division of Obstetrics and GynecologyThe University of Western AustraliaPerthWestern AustraliaAustralia
- Maternal Fetal Medicine Service, King Edward Memorial HospitalPerthWestern AustraliaAustralia
| | - Scott W. White
- Division of Obstetrics and GynecologyThe University of Western AustraliaPerthWestern AustraliaAustralia
- Maternal Fetal Medicine Service, King Edward Memorial HospitalPerthWestern AustraliaAustralia
| | - Yee Leung
- Division of Obstetrics and GynecologyThe University of Western AustraliaPerthWestern AustraliaAustralia
- Department of Gynecological OncologyKing Edward Memorial HospitalPerthWestern AustraliaAustralia
| | - Bligh Berry
- Department of Paediatric and Perinatal PathologyPathWest, Perth Children's HospitalPerthWestern AustraliaAustralia
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Yang J, Shi Z, Jia S, Liu J, Jiang L, Zhu Y. Systematic Evaluation and Nursing Outlook of Clinical Characteristics of 60 Twin Pregnancies with Complete Hydatidiform Mole and a Coexistent Viable Foetus. Patient Prefer Adherence 2023; 17:2631-2640. [PMID: 37920745 PMCID: PMC10618561 DOI: 10.2147/ppa.s428330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023] Open
Abstract
Objective To analyse the clinical data of and provide a reference for the care and perinatal health care of twin pregnancy patients with complete hydatidiform mole and a coexistent foetus (CHM & CF). Methods We searched the China National Knowledge Infrastructure (CNKI) and Wanfang and VIP databases to comprehensively collect clinical studies on the "clinical characteristics of complete hydatidiform mole and coexisting foetal twin pregnancy". Patients' data were extracted from the literature, and 60 patients were divided into Group A (live newborns not delivered, 47) and Group B (live newborns delivered, 13). The clinical characteristics of the two groups were compared to explore the pregnancy outcomes and influencing factors of persistent gestational trophoblastic disease (pGTD) in patients with CHM & CF. Results The gestational week of diagnosis (Odd Ratio (OR)=0.203, 95% Confidence Interval (CI)=0.055-0.753) and number of complications (OR=0.328, 95% CI=0.135-0.793) were found to be independent influencing factors of pregnancy outcomes in patients with CHM & CF (p < 0.05). Ovulation induction therapy (OR=2.333, 95% CI=0.561-9.708), preeclampsia (OR=75.000, 95% CI=11.041-509.486) and the number of complications (OR=4.768, 95% CI=1.914-11.875) were the independent influencing factors of developing pGTD (p < 0.05). Conclusion Pregnancy should not be terminated immediately after the early detection of CHM & CF, and multiple factors should be considered. Preeclampsia may indicate a poor prognosis, and ovulation induction may increase the incidence of pGTD. Targeted nursing and psychological nursing should be carried out according to the clinical symptoms of the patients.
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Affiliation(s)
- Jing Yang
- Department of Obstetrics, Suzhou Municipal Hospital, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Zhan Shi
- Department of Obstetrics, Suzhou Municipal Hospital, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Shafeng Jia
- Department of Obstetrics, Suzhou Municipal Hospital, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Jia Liu
- Department of Nursing Department, Gusu School, Nanjing Medical University, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Ling Jiang
- Department of Nursing Department, Gusu School, Nanjing Medical University, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Yueqin Zhu
- Department of Nursing Department, Gusu School, Nanjing Medical University, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
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Ulrikh E, Dikareva E, Govorov I, Komlichenko E, Pervunina T, Li O, Zhamborova O, Dzharbaeva A, Deynega V, Artemenko V, Urmancheeva A. Gestational Trophoblastic Disease with Coexisting Progressing Pregnancy: Personalised Treatment Modalities. Int J Clin Pract 2023; 2023:5502317. [PMID: 37927849 PMCID: PMC10622598 DOI: 10.1155/2023/5502317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 09/09/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose Gestational trophoblastic disease (GTD) coexisting with a steadily progressing pregnancy is an extremely rare condition presented in the literature as a single case or case series of successful delivery. The purpose of this study was to describe five cases of GTD and present possible management strategies for such patients. Methods Clinical data of five pregnancies with coexisting GTD were identified within the Almazov National Medical Research Centre from 2018 to 2021. Results Three cases of multiple pregnancies with complete hydatidiform moles and two cases of singleton pregnancies with intraplacental choriocarcinoma and invasive hydatidiform moles were identified. Three pregnancies were prolonged and ended with preterm deliveries. Malignant transformation of the GTD accounted for 60% of the cases. The condition of newborns was based on the level of prematurity and functional immaturity, and in all cases, it was aggravated by anemia. Conclusion GTD coexisting with progressing pregnancy is threatened by the risks of preterm delivery, miscarriage, hemorrhage, and disease progression and requires monitoring in a multidisciplinary clinic experienced in the management of patients with malignant tumors during pregnancy. In cases of prolonged pregnancy against the background of GTD, we suggest the following monitoring during pregnancy: pelvic, abdominal ultrasound/MRI (without contrast), prenatal invasive fetal karyotype testing in cases of singleton pregnancy, lung X-ray/CT with uterine shielding, weekly assessment of β-hCG levels, and dynamic monitoring of the fetus. The following postnatal monitoring should be performed: morphological examination of the placenta, weekly assessment of β-hCG levels up to normalization, then monthly assessment up to six months, and control of β-hCG level of the newborn.
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Affiliation(s)
- Elena Ulrikh
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Elena Dikareva
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Igor Govorov
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Eduard Komlichenko
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Tatiana Pervunina
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Olga Li
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Oksana Zhamborova
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Aminat Dzharbaeva
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Viktor Deynega
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Veronika Artemenko
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Adel Urmancheeva
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
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Bursać D, Horvat M, Culej D, Lučić D, Marinović L, Zmijanac Partl J. Prenatal diagnosis and management of pregnancy complicated by a coexisting mole: A case report. Radiol Case Rep 2023; 18:3410-3413. [PMID: 37502473 PMCID: PMC10369388 DOI: 10.1016/j.radcr.2023.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
Twin pregnancies with a complete hydatidiform mole and a coexisting live fetus are rare. The incidence is estimated to be 1 in 20,000-100,000 pregnancies. Prenatal diagnosis can be made with ultrasound findings, abnormally elevated β-hCG levels, and fetal karyotype. There are various complications following these pregnancies which include hyperemesis gravidarum, vaginal bleeding, spontaneous abortion, pre-eclampsia, intrauterine growth retardation, preterm delivery, and persistent trophoblastic disease. We report an interesting case of twin pregnancy consisting of a complete hydatidiform mole and a normal fetus achieved with in-vitro fertilization in a primary infertile couple. Suspicion of molar pregnancy was made on ultrasound examination, but the couple refused other prenatal testing and wanted to continue the pregnancy. Although the pregnancy was at high risk because of the patient's age and complications associated with a molar pregnancy, a vigorous female baby was delivered at term. The purpose of this report is to present a case of a rare obstetric condition, give evidence that gestational trophoblastic disease is occurring more commonly in multiple gestations and in-vitro fertilization pregnancies, and highlight the importance of ultrasound in prenatal diagnostics and monitoring of high-risk pregnancies.
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Affiliation(s)
- Danijel Bursać
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
- Department of Nursing, University North, Varaždin, Croatia
| | | | - Diana Culej
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
| | - Dejana Lučić
- Department of Obstetrics and Gynecology, Polyclinic “Vaš Pregled”, Zagreb, Croatia
| | - Lovro Marinović
- Department of Pathology and Cytology, University Hospital Merkur, Zagreb, Croatia
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Song S, Kim M, Koh JH, Kang OJ, Oh D, Lee SH, Lee SJ, Ahn JW, Roh HJ, Kim KR, Kim JS. Chimeric Singleton Placenta Comprising Placental Mesenchymal Dysplasia and Complete Hydatidiform Mole with Live Birth and Postpartum Diagnosis of Gestational Trophoblastic Neoplasia. Gynecol Obstet Invest 2023; 88:314-321. [PMID: 37442099 DOI: 10.1159/000531864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Placental mesenchymal dysplasia (PMD) is a benign lesion that is often misdiagnosed as complete (CHM) or partial hydatidiform mole. PMD usually results in live birth but can be associated with several fetal defects. Herein, we report PMD with CHM in a singleton placenta with live birth. CASE PRESENTATION A 34-year-old gravida 2, para 1, living 1 (G2P1L1) woman was referred on suspicion of a molar pregnancy in the first trimester. Maternal serum human chorionic gonadotrophin levels were increased during early pregnancy, with multicystic lesions and placentomegaly observed on ultrasonography. Levels decreased to normal with no fetal structural abnormalities observed. A healthy male infant was delivered at 34 gestational weeks. Placental p57KIP2 immunostaining and short tandem repeat analysis revealed three distinct histologies and genetic features: normal infant and placenta, PMD, and CHM. Gestational trophoblastic neoplasia was diagnosed and up to fourth-line chemotherapy administered. CONCLUSION Distinguishing PMD from hydatidiform moles is critical for avoiding unnecessary termination of pregnancy. CHM coexisting with a live fetus rarely occurs. This case is unique in that a healthy male infant was born from a singleton placenta with PMD and CHM.
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Affiliation(s)
- Seungyeon Song
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Misung Kim
- Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ji Hye Koh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ok Ju Kang
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - DaSol Oh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Sang-Hun Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Soo-Jeong Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Jun-Woo Ahn
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hyun-Jin Roh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Kyu-Rae Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Sook Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
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Ravn K, Hatt L, Singh R, Schelde P, Hansen ES, Vogel I, Uldbjerg N, Niemann I, Sunde L. Diagnosis of hydatidiform moles using circulating gestational trophoblasts isolated from maternal blood. Placenta 2023; 135:7-15. [PMID: 36889013 DOI: 10.1016/j.placenta.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/27/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Identifying hydatidiform moles (HMs) is crucial due to the risk of gestational trophoblastic neoplasia. When a HM is suspected on clinical findings, surgical termination is recommended. However, in a substantial fraction of the cases, the conceptus is actually a non-molar miscarriage. If distinction between molar and non-molar gestations could be obtained before termination, surgical intervention could be minimized. METHODS Circulating gestational trophoblasts (cGTs) were isolated from blood from 15 consecutive women suspected of molar pregnancies in gestational week 6-13. The trophoblasts were individually sorted using fluorescence activated cell sorting. STR analysis targeting 24 loci was performed on DNA isolated from maternal and paternal leukocytes, chorionic villi, cGTs, and cfDNA. RESULTS With a gestational age above 10 weeks, cGTs were isolated in 87% of the cases. Two androgenetic HMs, three triploid diandric HMs, and six conceptuses with diploid biparental genome were diagnosed using cGTs. The STR profiles in cGTs were identical to the profiles in DNA from chorionic villi. Eight of the 15 women suspected to have a HM prior to termination had a conceptus with a diploid biparental genome, and thus most likely a non-molar miscarriage. DISCUSSION Genetic analysis of cGTs is superior to identify HMs, compared to analysis of cfDNA, as it is not hampered by the presence of maternal DNA. cGTs provide information about the full genome in single cells, facilitating estimation of ploidy. This may be a step towards differentiating HMs from non-HMs before termination.
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Affiliation(s)
| | - Lotte Hatt
- ARCEDI Biotech, Tabletvej 1, Vejle, Denmark
| | | | | | | | - Ida Vogel
- Center for Fetal Diagnostics, Institute for Clinical Medicine, Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Women's Disease and Birth, Aarhus University Hospital, Aarhus, Denmark
| | - Isa Niemann
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Sunde
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark.
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Rai S, Yasaswi K, Raj R, Hiremath R, Ghodke S. Molar pregnancy with a coexistent fetus following assisted reproductive techniques: Two case reports. JOURNAL OF MARINE MEDICAL SOCIETY 2023. [DOI: 10.4103/jmms.jmms_90_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Case Report of a Triplet Pregnancy with Complete Hydatidiform Mole and Coexisting Twins. Case Rep Obstet Gynecol 2022; 2022:2865342. [PMID: 35966886 PMCID: PMC9371886 DOI: 10.1155/2022/2865342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Triplet pregnancy with complete hydatidiform mole and coexisting twin fetuses is extremely rare with an unknown incidence. Case Here, we present a case report of a pregnancy with twin fetuses and concurrent hydatidiform mole that resulted in the preterm delivery of one viable baby, the unfortunate intrauterine demise of the other twin, and successful treatment of gestational trophoblastic neoplasia in the postpartum period. Conclusion This case highlights several important questions that arise for women who choose to carry a multiple gestation pregnancy with complete hydatidiform mole and describes complications that can occur. It is imperative to accurately assess risks and counsel individuals who elect to carry these pregnancies to provide the best possible outcomes.
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Twin/Multiple Gestations With a Hydatidiform Mole: Clinicopathologic Analysis of 21 Cases With Emphasis on Molecular Genotyping and Parental Contribution. Am J Surg Pathol 2022; 46:1180-1195. [PMID: 35796652 DOI: 10.1097/pas.0000000000001893] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Complete hydatidiform moles (CHMs) and partial hydatidiform moles (PHMs) are abnormal gestations characterized by vesicular chorionic villi accompanied by variable trophoblastic hyperplasia, with or without embryonic development. CHMs are purely androgenetic (only paternal [P] chromosome complements), mostly homozygous/monospermic (~85%) but occasionally heterozygous/dispermic, whereas PHMs are overwhelmingly diandric triploid (2 paternal [P] and 1 maternal [M] chromosome complements) and heterozygous/dispermic (>95%). The presence of a fetus in a molar pregnancy usually indicates a PHM rather than a CHM; however, CHMs and PHMs rarely can be associated with a viable fetus or a nonmolar abortus in twin pregnancies and rare multiple gestation molar pregnancies have been reported. A "one-oocyte-model," with diploidization of dispermic triploid zygotes, has been proposed for twin CHM with coexisting fetus, and a "two-oocyte-model" has been proposed for twin PHM with coexisting fetus. Among 2447 products of conception specimens, we identified 21 cases of twin/multiple gestations with a molar component, including 20 CHMs (17 twins, 2 triplets, 1 quintuplet) and 1 PHM (twin). P57 immunohistochemistry was performed on all; DNA genotyping of molar and nonmolar components was performed on 9 twin CHMs, 1 triplet CHM, 1 quintuplet CHM, and 1 twin PHM. All CHM components were p57-negative and those genotyped were purely androgenetic. Twin CHMs had genotypes of P1M1+P2P2 in 5, P1M1+P1P1 in 1, and P1M1+P2P3 in 1, consistent with involvement of 1 oocyte and from 1 to 3 sperm-most commonly a homozygous CHM but involving 2 sperm in the whole conception-and compatible with a "one-oocyte-model." The triplet CHM was P1M1+P1P1+P2M2 and the quintuplet CHM was P1M1+P2M2+P2M2+P3M3+P4P4, consistent with involvement of 2 sperm and at least 2 oocytes for the triplet and 4 sperm and at least 3 oocytes for the quintuplet. The twin PHM had a P1M1+P2P3M2 genotype, consistent with involvement of 2 oocytes and 3 sperm. p57 immunohistochemistry is highly reliable for diagnosis of CHMs in twin/multiple gestations. Refined diagnosis of molar twin/multiple gestations is best accomplished by correlating morphology, p57 immunohistochemistry, and molecular genotyping, with the latter clarifying zygosity/parental chromosome complement contributions to these conceptions.
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Liang H, Pan NP, Wang YF, Ye CS, Yan ZQ, Wu RJ. Obstetrical and oncological outcomes of twin pregnancies with hydatidiform mole and coexisting fetus. Taiwan J Obstet Gynecol 2022; 61:453-458. [PMID: 35595437 DOI: 10.1016/j.tjog.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the obstetrical and oncological progression of twin pregnancies with hydatidiform mole coexisting fetus (HMCF). MATERIALS AND METHODS Using a retrospective method based on patients from the Women's Hospital, Zhejiang University School of Medicine database between January 1990 and October 2020, 17 patients were histologically confirmed as having HMCF, and the patients' prenatal diagnosis, outcomes and development of gestational trophoblastic neoplasia (GTN) were reviewed. RESULTS Among these 17 cases, 11 (64.71%) cases were complete hydatidiform mole coexisting fetus (CHMCF), and 6 (35.29%) cases were partial hydatidiform mole coexisting fetus (PHMCF). The gestational age at diagnosis of CHMCF was significantly earlier than that of PHMCF [9 (8-24) vs. 18 (11-32) weeks, respectively, P < 0.05]. The live birth rate of PHMCF was slightly higher than that of CHMCF (33.33%; 18.18%), but this difference was not statistically significant. The overall rate of GTN incidence of HMCF was 47.06% (8/17), and the GTN rates of PHMCF and CHMCF were 33.33% (2/6) and 54.55% (6/11), respectively. There was no significant difference in the GTN rate between patients who chose to continue pregnancy and those who terminated pregnancy before 24 weeks of gestation. The GTN rate of patients with term delivery was not significantly higher than that of preterm delivery. CONCLUSION In HMCF cases, the incidence rate of CHMCF was higher than that of PHMCF, and PHMCF is more difficult to diagnose in the early stage. Continuing pregnancy does not increase the risk of GTN compared to terminating pregnancy. In cases of HMCF, when the fetal karyotype is normal and maternal complications are controlled, it is safe to continue the pregnancy and extend it to term.
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Affiliation(s)
- Hui Liang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Ning-Ping Pan
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Yin-Feng Wang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Chao-Shuang Ye
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Zhu-Qing Yan
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Rui-Jin Wu
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China.
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11
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Wang G, Cao J, Xu X, Han X, Cui H. Delivery management of a complete hydatidiform mole and co-existing viable fetus: A meta-analysis and systematic review. J Gynecol Obstet Hum Reprod 2022; 51:102269. [PMID: 34767996 DOI: 10.1016/j.jogoh.2021.102269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A twin pregnancy with a complete hydatidiform mole and co-existing viable fetus (CHMCF) is an exceedingly rare obstetric complication with few data related to perinatal treatment. This study determined the optimal timing of pregnancy termination and mode of delivery in women with CHMCF and a viable fetus. METHODS The articles published involving CHMCF and a viable fetus from 1967 to 31 December 2020 in the PubMed and EMBASE databases were systematically reviewed. Observational cohort studies with three or more cases identified and data on delivery management were selected. The articles were analyzed independently for full text and the data were integrated. The timing of pregnancy termination and mode of delivery were calculated using Review Manager 5.4.1. RESULTS There were 192 reports involving CHMCF; 209 cases had a viable fetus. According to the inclusion criteria, there were 6 case series, including 72 cases that were eligible for the analysis. The average rate of live births was 34.4%. The average duration of pregnancy was 34 weeks, ranging from 25 to 41 weeks. From 2000-2017 the live birth rate was increased year-after-year. Specifically, the live birth rate was16.7% in 2000, 33.3% in 2012, and 50% in 2017. Fifty-two cases (72.2%) had cesarean sections and 20 cases (27.8%) had vaginal deliveries. The incidence of gestational trophoblastic neoplasia was not significantly different between the two modes of delivery. CONCLUSIONS Ideally, a twin pregnancy with a complete hydatidiform mole co-existing with a viable fetus is managed by an obstetrician, pediatrician, and oncologist. Appropriate timing of pregnancy termination and mode of delivery are related to the pregnancy outcome.
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Affiliation(s)
- Guan Wang
- Department of Obstetrics, Tianjin Central Hospital of Gynecology Obstetrics/Tianjin Key Laboratory of human development and reproductive regulation, Tianjin, 300100, China
| | - Jiasong Cao
- Tianjin Key Laboratory of human development and reproductive regulation, Tianjin Central Hospital of Gynecology Obstetrics/Tianjin Key Laboratory of human development and reproductive regulation, Tianjin, 300100, China
| | - Xinran Xu
- Department of Obstetrics, Tianjin Central Hospital of Gynecology Obstetrics/Tianjin Key Laboratory of human development and reproductive regulation, Tianjin, 300100, China
| | - Xueling Han
- Department of Obstetrics, Tianjin Central Hospital of Gynecology Obstetrics/Tianjin Key Laboratory of human development and reproductive regulation, Tianjin, 300100, China
| | - Hongyan Cui
- Department of Obstetrics, Tianjin Central Hospital of Gynecology Obstetrics/Tianjin Key Laboratory of human development and reproductive regulation, Tianjin, 300100, China.
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Lin M, Chen J, Liao B, He Z, Lin S, Luo Y. When a vesicular placenta meets a live fetus: case report of twin pregnancy with a partial hydatidiform mole. BMC Pregnancy Childbirth 2021; 21:694. [PMID: 34645420 PMCID: PMC8513365 DOI: 10.1186/s12884-021-04160-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hydatidiform moles exhibit a distinctive gross appearance of multiple vesicles in the placenta. The advances in cytogenetic technologies have helped uncover novel entities of hydatidiform moles and enabled elaborate diagnoses. However, management of a vesicular placenta with a coexistent live fetus poses a bigger challenge beyond hydatidiform moles. CASE PRESENTATION A 33-year-old woman was referred to our department for suspected hydatidiform mole coexistent with a live fetus at 24 weeks' gestation. The patient had conceived through double embryo transplantation, and first-trimester ultrasonography displayed a single sac. Mid-trimester imaging findings of normal placenta parenchyma admixed with multiple vesicles and a single amniotic cavity with a fetus led to suspicion of a singleton partial molar pregnancy. After confirmation of a normal diploid by amniocentesis and close surveillance, the patient delivered a healthy neonate. Preliminary microscopic examination of the placenta failed to clarify the diagnosis until fluorescence in situ hybridization showed a majority of XXY sex chromosomes. The patient developed suspected choriocarcinoma and achieved remission for 5 months after chemotherapy, but relapsed with suspected intermediate trophoblastic tumor. CONCLUSION We report a rare case of twin pregnancy comprising a partial mole and a normal fetus that resembled a singleton partial molar pregnancy. Individualized care is important in conditions where a vesicular placenta coexists with a fetus. We strongly recommend ancillary examinations in addition to traditional morphologic assessment in such cases.
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Affiliation(s)
- Minhuan Lin
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Lu, Guangzhou, China
| | - Jinzhu Chen
- Department of Obstetrics & Gynecology, Quanzhou First Hospital Affiliated to Fujian Medical University, No.215, Wen Ling Nan Lu, Quanzhou, China
| | - Bing Liao
- Department of Pathology, the First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Lu, Guangzhou, China
| | - Zhiming He
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Lu, Guangzhou, China
| | - Shaobin Lin
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Lu, Guangzhou, China
| | - Yanmin Luo
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Sun Yat-Sen University, No.58, Zhong Shan Er Lu, Guangzhou, China.
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Alpay V, Kaymak D, Erenel H, Cepni I, Madazli R. Complete Hydatidiform Mole and Co-Existing Live Fetus after Intracytoplasmic Sperm Injection: A Case Report and Literature Review. Fetal Pediatr Pathol 2021; 40:493-500. [PMID: 31997691 DOI: 10.1080/15513815.2019.1710790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Twin pregnancy with complete hydatidiform mole and co-existing fetus (CHMCF) is an uncommon obstetric entity and may occur after assisted reproductive technologies. These pregnancies are associated with severe complications for both mother and fetus and the management is challenging. Case Report: We report a twin pregnancy after intracytoplasmic sperm injection (ICSI) treatment with CHMCF which delivered at 26 gestation weeks due to severe preeclampsia. The 625g neonate survived without any complication. The woman had persistent trophoblastic disease with lung metastasis and was treated with single agent methotrexate. We also present a brief review of the literature about the outcomes of CHMCF after ICSI. Conclusion: CHMCF may occur after ICSI treatment. Pregnancies with CHMCF are associated with severe complications however under close follow-up successful outcomes could be achieved in such pregnancies.
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Affiliation(s)
- Verda Alpay
- Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Didem Kaymak
- Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Hakan Erenel
- Obstetrics and Gynecology, Division of Perinatology, Istanbul Universitesi Cerrahpasa Tip Fakultesi, Istanbul, Turkey
| | - Ismail Cepni
- Obstetrics and Gynecology, Istanbul Üniversitesi-Cerrahpasa, Istanbul, Turkey
| | - Riza Madazli
- Obstetrics and Gynecology, Istanbul Üniversitesi-Cerrahpasa, Istanbul, Turkey
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14
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Taira Y, Shimoji Y, Nakasone T, Arakaki Y, Nakamoto T, Kinjo T, Kudaka W, Mekaru K, Aoki Y. A high-risk gestational trophoblastic neoplasia derived from a complete hydatidiform mole with coexisting fetus identified by short tandem repeats analysis: A case report. Case Rep Womens Health 2021; 31:e00336. [PMID: 34195021 PMCID: PMC8233190 DOI: 10.1016/j.crwh.2021.e00336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
A complete hydatidiform mole coexisting with a fetus (CHMCF) is a rare form of twin pregnancy. High-risk gestational trophoblastic neoplasia (GTN) can occur after a CHMCF pregnancy, although the frequency is low. In cases of GTN, the clinical diagnosis and that based on the International Federation of Gynecology and Obstetrics (FIGO) scoring system can differ. This case report concerns a patient with a choriocarcinoma that was initially diagnosed and treated as a low-risk stage III GTN following a live birth from a CHMCF pregnancy. We used short tandem repeat (STR) analysis to identify the causative pregnancy as the patient's earlier complete hydatidiform mole. Clinicians should anticipate a high-risk GTN when treating persistent trophoblastic disease (PTD) in patients with a non-typical course. A fetus and a complete hydatidiform mole can coexist as a twin pregnancy. A complete hydatidiform mole coexisting with a fetus can rarely cause choriocarcinoma. Short tandem repeat analysis can be used to identify causative pregnancies. Causative pregnancy is a risk factor for persistent trophoblastic disease.
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15
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McNally L, Rabban JT, Poder L, Chetty S, Ueda S, Chen LM. Differentiating complete hydatidiform mole and coexistent fetus and placental mesenchymal dysplasia: A series of 9 cases and review of the literature. Gynecol Oncol Rep 2021; 37:100811. [PMID: 34189230 PMCID: PMC8220337 DOI: 10.1016/j.gore.2021.100811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
Twin mole and placental mesenchymal dysplasia are set apart by patient symptoms, labs, and imaging. Continuing with a twin mole pregnancy does not appear to increase the risk of GTN. Twin mole pregnancy does carry an increased risk of miscarriage and pre-term labor.
To identify the differentiating features in clinical presentation, management, and maternal/fetal outcome in complete hydatidiform mole and coexistent fetus compared with placental mesenchymal dysplasia. Between 1997 and 2015, five women with complete hydatidiform mole and coexistent fetus and four women with placental mesenchymal dysplasia were managed at the University of California San Francisco. Clinical features were analyzed and compared with previously published data. Of the five cases of complete hydatidiform mole and coexistent fetus, two had live births. β-hCG levels were > 200,000 IU/L in all cases. On imaging, a clear plane between the cystic component and the placenta favored a diagnosis of complete hydatidiform mole and coexistent fetus. None of the patients went on to develop gestational trophoblastic neoplasia (GTN), with a range of follow-up from 2 to 38 months. Combining this data with previously published work, the live birth rate in these cases was 38.8%, the rate of persistent GTN was 36.2%, and the rate of persistent GTN in patients with reported live births was 27%. Of the four cases of placental mesenchymal dysplasia, all four had live births. One patient developed HELLP syndrome and intrauterine growth restriction; the remaining three were asymptomatic. Maternal symptoms, fetal anomalies, β-hCG level, and placental growth pattern on imaging may help differentiate between complete hydatidiform mole and coexistent fetus and placental mesenchymal dysplasia. There was not an increased risk of gestational trophoblastic neoplasia in patients with complete hydatidiform mole and coexistent fetus who opted to continue with pregnancy.
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Affiliation(s)
- Leah McNally
- Division of Gynecologic Oncology, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, United States
| | - Joseph T Rabban
- Department of Pathology, University of California San Francisco, United States
| | - Liina Poder
- Department of Radiology, University of California San Francisco, United States
| | - Shilpa Chetty
- Division of Maternal Fetal Medicine, University of California San Francisco, United States
| | - Stefanie Ueda
- Division of Gynecologic Oncology, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, United States
| | - Lee-May Chen
- Division of Gynecologic Oncology, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, United States
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16
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Zilberman Sharon N, Maymon R, Melcer Y, Jauniaux E. Obstetric outcomes of twin pregnancies presenting with a complete hydatidiform mole and coexistent normal fetus: a systematic review and meta-analysis. BJOG 2020; 127:1450-1457. [PMID: 32339446 DOI: 10.1111/1471-0528.16283] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidemiological data on obstetric and oncologic complications in twin pregnancies combining a complete hydatidiform mole (CHM) coexisting with a normal fetus and placenta are limited. OBJECTIVES To evaluate perinatal and obstetric outcomes for mother and fetus and risk of gestational trophoblastic neoplasia (GTN) in twin pregnancies including a CHM. SEARCH STRATEGY PubMed, MEDLINE and EMBASE and the grey literature were searched for articles published between May 1980 and May 2019 using a protocol designed a priori and registered on PROSPERO (CRD42018112524). SELECTION CRITERIA Observational cohort studies of four or more cases confirmed by histopathology and providing data on pregnancy outcomes and GTN. DATA COLLECTION AND ANALYSIS Two reviewers independently reviewed abstracts and full-text articles. The quality of the studies was assessed with the Newcastle-Ottawa scale and a meta-analysis was performed. MAIN RESULTS Of the 344 abstracts identified, 14 studies (244 cases) met the eligibility criteria. The incidence of maternal complication in ongoing pregnancies was 80.8% and included vaginal bleeding, hyperthyroidism and pre-eclampsia. There were overall 91 (50%) live births in ongoing pregnancies and 83 (34%) of the total cases were subsequently diagnosed with GTN. Substantial and significant (P < 0.001) heterogeneity was found for the incidence of preeclampsia indicating variability in reporting the incidence of some obstetric complications between studies. CONCLUSIONS Patients diagnosed with a twin pregnancy combining a CHM and an apparently normal fetus have a high risk of perinatal complications, low live-birth rates and around a third of them will develop a GTN and should be managed by specialised multidisciplinary teams. TWEETABLE ABSTRACT Our study indicates a high rate of obstetric and oncologic complications in patients presenting with a complete hydatidiform mole and coexistent normal fetus.
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Affiliation(s)
- N Zilberman Sharon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Jauniaux
- Faculty of Population Health Sciences, EGA Institute for Women's Health, University College London, London, UK
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17
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Liu Y, Zheng X, Wang Y, Li Y, Liu C. Identification of a hydatidiform mole in twin pregnancy following assisted reproduction. J Assist Reprod Genet 2019; 37:603-610. [PMID: 31833013 DOI: 10.1007/s10815-019-01650-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The aim of this study was to identify a co-existing hydatidiform mole (HM) in twin pregnancy from the abnormal mixed-genomic products of conception (POC) after assisted reproduction by histopathological review, evaluation of p57kip2 immunostaining and short tandem repeat genotyping. METHODS Thirty-seven patients were collected with suspicion for HM by pathological morphology. They had two embryos individually transferred to their uterus after in vitro fertilization and presented two gestational sacs with undeveloped embryos or one sac with an abnormal area by ultrasonography. RESULTS Thirty patients were diagnosed as singleton pregnancy, including twenty-two non-molar gestations, six trisomy gestations, one homozygous complete mole and one heterozygous partial mole. Although six patients had ultrasonic imaging of two gestational sacs, the embryonic components in the vacant sac might fade away after transferring. Other seven patients were considered as twin pregnancy by the allelic genotype from two individual conceptions. For the patients with uniform p57kip2 positivity, excessive paternal alleles indicated the potential partial HM in the twin pregnancy. For the patients demonstrated divergent and/or discordant p57kip2 immunostaining, twin pregnancy with co-existing complete HM or mosaic conception were confirmed by genotyping of different villi population respectively. These patients were monitored by serum β-HCG, while one twin pregnancy with complete mole suffered invasive mole and received chemotherapy. CONCLUSIONS A strategy composed of selective clinicopathological screening, immunohistochemical interpretation and accurate genotyping is recommended for diagnostically challenging mixed-genomic POC of potential twin pregnancy with HM, especially to differentiate a non-molar mosaic conception from a partial mole.
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Affiliation(s)
- Yan Liu
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, China.
| | - Xingzheng Zheng
- Department of Pathology, Capital Medical University Beijing Obstetrics and Gynecology Hospital, Beijing, 100123, China
| | - Yuxiang Wang
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, China
| | - Yan Li
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, China
| | - Congrong Liu
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, China.
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18
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Lipi LB, Philp L, Goodman AK. A challenging case of twin pregnancy with complete hydatidiform mole and co-existing normal live fetus - A case report and review of the literature. Gynecol Oncol Rep 2019; 31:100519. [PMID: 31890831 PMCID: PMC6926326 DOI: 10.1016/j.gore.2019.100519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/12/2019] [Indexed: 12/03/2022] Open
Abstract
Twin pregnancy with complete hydatidiform mole and co-existing normal live fetus is rare. Antenatal and postpartum complications such as gestational trophoblastic neoplasia are common. Patients require close clinical monitoring and urgent delivery in the setting of complications. Follow-up with serum β-HCG is important for the diagnosis of persistent trophoblastic disease.
Hydatidiform mole coexisting with a normal live fetus in a twin pregnancy is extremely rare. Management of these cases is challenging due to the risk of severe antepartum and post-partum complications. Herein, we report the case of a 24-year-old gravida 2 para 1 who presented at 28 weeks gestation with severe preeclampsia, vulvar edema and a serum β-HCG of 285,000 IU/mL. Ultrasonography demonstrated a single live intra-uterine pregnancy with concurrent hydatidiform mole. Conservative management with magnesium sulfate and anti-hypertensive medications was initiated however the patient developed HELLP syndrome and required urgent delivery at 33 weeks. Copious molar tissue was removed from the uterus during delivery. Four weeks post-partum, her β-HCG had dropped to 14,000 IU/ml and continued to decline at 6 weeks (2900 IU/ml). However, at eight weeks, it increased to 3500 IU/ml and the patient was treated with nine cycles of intramuscular methotrexate. Current guidelines for management of a twin pregnancy with coexistent mole recommend close clinical monitoring if the mother and fetus are stable and urgent delivery in the setting of complications. During the postpartum period, careful follow up with clinical evaluation and serial serum β-HCG is important for the diagnosis and treatment of persistent trophoblastic disease.
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Affiliation(s)
- L B Lipi
- Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - L Philp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - A K Goodman
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, United States
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19
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Braga A, Obeica B, Werner H, Sun SY, Amim Júnior J, Filho JR, Araujo Júnior E. A twin pregnancy with a hydatidiform mole and a coexisting live fetus: prenatal diagnosis, treatment, and follow-up. J Ultrason 2017; 17:299-305. [PMID: 29375907 PMCID: PMC5769672 DOI: 10.15557/jou.2017.0044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022] Open
Abstract
Twin molar pregnancy with a hydatidiform mole and a coexisting live fetus is a rare form of gestational trophoblastic disease associated with an increased risk of obstetric complications and poor perinatal outcome. Prenatal diagnosis is essential for couple counseling and follow-up in Tertiary Reference Centers. Magnetic resonance imaging is important for the diagnostic differentiation of placental mesenchymal dysplasia and exclusion of myometrial invasion. Here we present a case of twin molar pregnancy with a hydatidiform mole and a coexisting live fetus diagnosed at gestational week 14 using two-dimensional (2D) and three-dimensional (3D) ultrasound and magnetic resonance imaging. We also describe the obstetric management and postmolar follow-up.
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Affiliation(s)
- Antonio Braga
- Rio de Janeiro Trophoblastic Disease Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruna Obeica
- Rio de Janeiro Trophoblastic Disease Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Heron Werner
- Department of Radiology, Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil
| | - Sue Yazaki Sun
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil
| | - Joffre Amim Júnior
- Rio de Janeiro Trophoblastic Disease Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Rezende Filho
- Rio de Janeiro Trophoblastic Disease Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil
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20
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Kubelka-Sabit KB, Prodanova I, Jasar D, Bozinovski G, Filipovski V, Drakulevski S, Plaseska-Karanfilska D. Molecular and Immunohistochemical Characteristics of Complete Hydatidiform Moles. Balkan J Med Genet 2017; 20:27-34. [PMID: 28924538 PMCID: PMC5596819 DOI: 10.1515/bjmg-2017-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Molar pregnancy is a gestational trophoblastic disease that belongs to the category of precancerous lesions. On the other end of the spectrum are gestational trophoblastic neoplasms such as invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor, which are considered malignant tumors. Based on defined histopathological criteria, molar pregnancy is divided into partial and complete hydatidiform mole. Especially in the case of early complete mole, the diagnosis can be quite challenging and often necessitates additional molecular or immunohistochemical methods. The aim of this study was to assess the importance of additional molecular and immunohistochemical methods to accurately diagnose complete hydatidiform mole and to stress the importance of correct diagnosis and close follow-up of these patients. A total of 367 consecutive cases of spontaneous abortion were analyzed in a 3-year period. Eight cases with histopathological diagnosis of complete molar pregnancy were selected for further analysis. Apart from standard microscopic analysis, additional molecular and immunohistochemical analyses were performed in all eight cases. Most of the histopathological characteristics of complete molar pregnancy were present in all cases, together with complete absence of positivity for the p57 immunohistochemical marker in the cytotrophoblasts and villous stromal cells. The molecular analysis revealed androgenetic diploidy in seven cases and biparental diploidy in one case with more than three consecutive complete molar pregnancies. Additional immunohistochemical and molecular methods can considerably aid in the correct diagnosis of molar pregnancy.
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Affiliation(s)
- KB Kubelka-Sabit
- Department of Histopathology and Cytology, Clinical Hospital “Acibadem-Sistina”, Skopje, Republic of Macedonia
- Dr. Katerina B. Kubelka-Sabit, Clinical Hospital Acibadem Sistina, Skupi 5a, 1000 Skopje, Republic of Macedonia. Tel: +389-70-365-338. Fax: +389-23-099-599. E-mail:
| | - I Prodanova
- Diagnostic Laboratory “Histolab”, Skopje, Republic of Macedonia
| | - D Jasar
- Department of Histopathology and Cytology, Clinical Hospital “Acibadem-Sistina”, Skopje, Republic of Macedonia
| | - G Bozinovski
- Macedonian Academy of Sciences and Arts, Research Centre for Genetic Engineering and Biotechnology “Georgi D. Efremov”, Skopje, Republic of Macedonia
| | - V Filipovski
- Department of Histopathology and Cytology, Clinical Hospital “Acibadem-Sistina”, Skopje, Republic of Macedonia
| | - S Drakulevski
- Department of Histopathology and Cytology, Clinical Hospital “Acibadem-Sistina”, Skopje, Republic of Macedonia
| | - D Plaseska-Karanfilska
- Macedonian Academy of Sciences and Arts, Research Centre for Genetic Engineering and Biotechnology “Georgi D. Efremov”, Skopje, Republic of Macedonia
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21
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Multiple pregnancies with complete mole and coexisting normal fetus in North and South America: A retrospective multicenter cohort and literature review. Gynecol Oncol 2017; 145:88-95. [DOI: 10.1016/j.ygyno.2017.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/12/2017] [Accepted: 01/19/2017] [Indexed: 11/18/2022]
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22
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Moriuchi K, Chigusa Y, Kondoh E, Io S, Hamanishi J, Mandai M. A case of complete hydatidiform mole with coexistent fetus developing hypertension and acute heart failure. HYPERTENSION RESEARCH IN PREGNANCY 2017. [DOI: 10.14390/jsshp.hrp2017-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kaori Moriuchi
- Department of Gynecology and Obstetrics, Kyoto University
| | | | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University
| | - Shingo Io
- Department of Gynecology and Obstetrics, Kyoto University
| | | | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University
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23
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Twin Pregnancy with Complete Hydatidiform Mole and Co-existent Live Fetus. JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-015-0070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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McNamara HC, Kane SC, Craig JM, Short RV, Umstad MP. A review of the mechanisms and evidence for typical and atypical twinning. Am J Obstet Gynecol 2016; 214:172-191. [PMID: 26548710 DOI: 10.1016/j.ajog.2015.10.930] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 12/11/2022]
Abstract
The mechanisms responsible for twinning and disorders of twin gestations have been the subject of considerable interest by physicians and scientists, and cases of atypical twinning have called for a reexamination of the fundamental theories invoked to explain twin gestations. This article presents a review of the literature focusing on twinning and atypical twinning with an emphasis on the phenomena of chimeric twins, phenotypically discordant monozygotic twins, mirror-image twins, polar body twins, complete hydatidiform mole with a coexistent twin, vanishing twins, fetus papyraceus, fetus in fetu, superfetation, and superfecundation. The traditional models attributing monozygotic twinning to a fission event, and more recent models describing monozygotic twinning as a fusion event, are critically reviewed. Ethical restrictions on scientific experimentation with human embryos and the rarity of cases of atypical twinning have limited opportunities to elucidate the exact mechanisms by which these phenomena occur. Refinements in the modeling of early embryonic development in twin pregnancies may have significant clinical implications. The article includes a series of figures to illustrate the phenomena described.
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Affiliation(s)
- Helen C McNamara
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia
| | - Stefan C Kane
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey M Craig
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Roger V Short
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark P Umstad
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
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25
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26
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Twin pregnancy with both complete hydatiform mole and coexistent alive fetus: Case report. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2015. [DOI: 10.1016/j.apjr.2015.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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27
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Sunde L, Lund H, J Sebire N, Grove A, Fisher RA, Niemann I, Kjeldsen E, Andreasen L, Hansen ES, Bojesen A, Bolund L, Nyegaard M. Paternal Hemizygosity in 11p15 in Mole-like Conceptuses: Two Case Reports. Medicine (Baltimore) 2015; 94:e1776. [PMID: 26554776 PMCID: PMC4915877 DOI: 10.1097/md.0000000000001776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hydatidiform mole is an abnormal human pregnancy characterized by the fetus being absent or nonviable, and the chorionic villi being vesicular and with trophoblastic hyperplasia. Most often, the mole phenotype is seen in conceptuses with an excess of paternally inherited genome set(s) relative to maternally inherited genome set(s), suggesting that the phenotype is caused by an excess of genome with a paternal imprinting pattern. However, it is unknown if correct parental origin of every imprinted gene is crucial for normal early differentiation or if abnormal parental imprinting of only one, or some, gene(s) can cause the mole phenotype.Two conceptuses included in the Danish Mole Project stood out since they presented with vesicular chorionic villi and without signs of fetal differentiation, and had apparently biparental diploid genomes, and no mutations in NLRP7 or KHDC3L were detected in the mothers. These conceptuses were subjected to a centralized histopathological revision and their genetic complements were scrutinized using fluorescence in situ hybridization, and DNA-marker and array comparative genomic hybridization analyses. Both conceptuses showed dysmorphic chorionic villi with some similarities to hydatidiform moles; however, no definite florid trophoblast hyperplasia was observed. Both conceptuses showed paternal hemizygosity of 11pter-11p15.4, most likely in nonmosaic state.Our findings suggest that the product of one (or a few) maternally expressed gene(s) on the tip of chromosome 11 is necessary for normal early embryonic differentiation. However, since the present two cases did not exhibit all features of hydatidiform moles, it is likely that abnormal parental imprinting of genes in other regions contribute to the phenotype of a hydatidiform mole.
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Affiliation(s)
- Lone Sunde
- From the Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark (LS); Institute of Pathology, Aalborg University Hospital, Aalborg, Denmark (HL, AG); Trophoblastic Tumour Screening and Treatment Centre, Department of Oncology, Imperial College Healthcare NHS (NJS, RF); Institute of Child Health, University College London (NJS); Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, London, UK (RF); Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N (IN); Hemodiagnostic Laboratory, CancercytogeneticSection, Aarhus University Hospital, Aarhus C, Denmark (EK); Department of Immunology and Biochemistry, Vejle Sygehus, Vejle, Denmark (LA); Department of Pathology, Aarhus University Hospital, Aarhus C, Denmark (EH); Department of Clinical Genetics, Vejle Sygehus, Vejle, Denmark (AB); Department of Biomedicine, Aarhus University, Aarhus C, Denmark (LS, LB, MN); and Beijing Genomics Institute/HuaDa-Shenzhen, Shenzhen, China (LB)
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Wang Y, Qian H, Wang J. Medical termination of a partial hydatidiform mole and coexisting fetus during the second trimester: A case report. Oncol Lett 2015; 10:3625-3628. [PMID: 26788180 DOI: 10.3892/ol.2015.3743] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022] Open
Abstract
Partial hydatidiform mole and coexisting fetus (PHMCF) is a rare condition that presents a dilemma for physicians and the parents of the fetus, particularly when PHMCF is detected during the second trimester of pregnancy. The present study reports a case of PHMCF terminated by induction of labor via administration of Rivanol at 17 weeks. Follow-up measurements of serum β-human chorionic gonadotropin (β-HCG) levels, as well as imaging studies, indicated the presence of persistent trophoblastic disease (PTD) and lung metastases. The patient was therefore admitted for three courses of chemotherapy. Subsequently, the metastases receded and β-HCG levels decreased to within the normal range. The patient demonstrated no disease recurrence for 1 year. Following a review of the relevant literature, to the best of our knowledge, all PHMCF cases terminated by medical induction of labor during the second trimester resulted in the development of PTD and lung metastases. However, three cases of PHMCF that were terminated by caesarean section during the third trimester did not develop PTD or metastases. The present study therefore hypothesized that medical termination may not be a safe therapeutic strategy for the treatment of PHMCF during the second trimester, and that pregnancy should be allowed to continue empirically.
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Affiliation(s)
- Yinfeng Wang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Honglang Qian
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Jinhua Wang
- Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
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Rohilla M, Singh P, Kaur J, Jain V, Gupta N, Prasad G. Individualistic approach to the management of complete hydatidiform mole with coexisting live fetus. Eur J Obstet Gynecol Reprod Biol 2015; 191:39-42. [DOI: 10.1016/j.ejogrb.2015.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/10/2015] [Accepted: 05/19/2015] [Indexed: 11/26/2022]
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de Marcillac F, Akladios CY, Hui-bon-hoa I, Fritz G, Nisand I, Langer B. [Twin pregnancy with complete hydatiform mole and coexistent fetus: Report of 4 cases and review of literature]. ACTA ACUST UNITED AC 2015; 44:840-7. [PMID: 25613826 DOI: 10.1016/j.jgyn.2014.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/16/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Twin pregnancy with complete hydatiform mole and coexistent fetus is a rare clinical condition, occurring in 1 in 22,000 to one in 100,000 pregnancies. Continuation of pregnancy in these cases is controversial because of a high risk of immediate and long-term maternal morbidity. It allows, however, in 33 % of the case the delivery of a healthy child. METHODS This retrospective study included all patients presenting a complete hydatiform mole coexisting with a live twin fetus antenatally diagnosed between 2007 and 2012 in the level III maternity of the Strasbourg University Hospital. Informations concerning diagnostic circumstances, pregnancy follow-up and outcome were studied. RESULTS Four pregnancies were included in the study, all of them were spontaneous. Medical termination of pregnancies was related to maternal reasons in the four cases. One before 17 weeks of gestation, the three other after 2 weeks of gestation, leading to delivery of a healthy child. All patients developed a mild to severe preeclampsia. One patient developed a gestational trophoblastic disease, requiring chemotherapy by methotrexate. There was no fatal evolution. CONCLUSION Twin pregnancy with complete hydatifom mole and coexistent fetus is associated with increased risk of gestational trophoblastic disease. This risk is not increased by continuation of pregnancy. In case of prenatal diagnosis of complete hydatiform mole coexisting with a live twin fetus, patients should be aware of the potential high risk of morbidity and a regular follow-up during and after the pregnancy should be intaured. In absence of maternal complications, continuation of the pregnancy is possible.
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Affiliation(s)
- F de Marcillac
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - C Y Akladios
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - I Hui-bon-hoa
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - G Fritz
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - I Nisand
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - B Langer
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
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Chen CP, Ko TM, Chen CY, Wang TY, Chern SR, Kuo YL, Wang W. First-trimester molecular diagnosis of complete hydatidiform mole associated with dizygotic twin pregnancy conceived by intrauterine insemination. Taiwan J Obstet Gynecol 2014; 53:572-8. [PMID: 25510703 DOI: 10.1016/j.tjog.2014.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To present first-trimester molecular diagnosis of complete hydatidiform mole (CHM) associated with dizygotic twin pregnancy conceived by intrauterine insemination. MATERIALS AND METHODS A 32-year-old woman presented to the hospital with a huge complex cystic mass measuring about 8.5 cm × 4.1 cm in the uterine cavity and a living co-existing fetus with fetal biometry equivalent to 9 weeks. She underwent chorionic villus sampling at 13 weeks of gestation, and microsatellite genotyping for molar pregnancy test was applied. A molar pregnancy test was performed by a short tandem repeat (STR) identifier polymerase chain reaction (PCR) polymorphic marker analysis. The pregnancy was terminated at 14 weeks of gestation. Postnatal polymorphic DNA marker analysis of the placenta by quantitative fluorescent PCR (QF-PCR) was performed. Analysis of maternal blood total β-human chorionic gonadotropin revealed a high level of 551,600 mIU/mL at 10 weeks of gestation and a level of 1.0 mIU/mL at 15 weeks postpartum. The woman was doing well at 4 months after delivery. RESULTS The results of STR identifier PCR polymorphic marker analysis showed androgenic conception in the complex cystic mass and biparental conception in the living fetus. Pathological analysis of the cystic mass confirmed the diagnosis of CHM. The results of QF-PCR showed biparental inheritance in the normal fetus and complete paternal homozygosity in the CHM of the abnormal fetus in all STRs, indicating dizygotic twinning and CHM of monospermy. CONCLUSION Prenatal sonographic diagnosis of placentomegaly with many grape-like vesicles should include a differential diagnosis of CHM, partial hydatidiform mole (PHM), placental mesenchymal dysplasia (PMD), and recurrent hydatidiform mole. Microsatellite genotyping for molar pregnancy testing and zygosity testing is useful in cases of prenatal diagnosis of placentomegaly associated with many grape-like vesicles and a twin pregnancy with a living fetus in the first trimester.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Tsang-Ming Ko
- Genephile Bioscience Laboratory, Ko's Obstetrics and Gynecology, Taipei, Taiwan
| | - Chen-Yu Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tao-Yeuan Wang
- Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Schu-Rern Chern
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Ling Kuo
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wayseen Wang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Bioengineering, Tatung University, Taipei, Taiwan
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Kutuk MS, Ozgun MT, Dolanbay M, Batukan C, Uludag S, Basbug M. Sonographic findings and perinatal outcome of multiple pregnancies associating a complete hydatiform mole and a live fetus: a case series. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:465-471. [PMID: 24867873 DOI: 10.1002/jcu.22169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 03/27/2014] [Accepted: 04/22/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The aim of this case series was to present the ultrasonographic findings, clinical features, management, and outcome of multiple pregnancies with complete hydatidiform mole and coexisting fetus (CHMCF). METHODS Sonographic features and obstetrical and perinatal outcomes of seven cases with CHMCF were analyzed retrospectively. RESULTS A total of seven cases was included in the analysis. Six cases were twins and one case was quadruplet. The mean ± SD maternal age was 25.3 ± 1.9 years (median: 25; range: 23-29). The mean gestational age at diagnosis was 16.1 ± 4.6 weeks (median: 17; range: 11-23). Two pregnancies were achieved by ovulation induction. Two couples opted for pregnancy termination. Four pregnancies resulted in fetal loss between the 11th and 23th week of gestation. One pregnancy ended with the preterm delivery of a live-born neonate at 34 weeks due to pre-eclampsia. One patient developed persistent trophoblastic disease, which was treated by hysterectomy. The mean ± SD time for β-human chorionic gonadotropin clearance was 3.7 ± 0.5 weeks (median: 4; range: 3-4) in the six patients without persistent trophoblastic disease. CONCLUSIONS Spontaneous fetal loss is the most likely outcome for CHMCF. However, on the basis of our experience, we recommend carefully monitored continuation of pregnancy as long as maternal complications are not present or are controllable.
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Affiliation(s)
- Mehmet Serdar Kutuk
- Erciyes University, Faculty of Medicine, Department of Obstetrics and Gynecology, Kayseri, Turkey
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Term delivery of a complete hydatidiform mole with a coexisting living fetus followed by successful treatment of maternal metastatic gestational trophoblastic disease. Taiwan J Obstet Gynecol 2014; 53:397-400. [DOI: 10.1016/j.tjog.2013.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 11/21/2022] Open
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Okumura M, Fushida K, Francisco RPV, Schultz R, Zugaib M. Massive necrosis of a complete hydatidiform mole in a twin pregnancy with a surviving coexistent fetus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:177-179. [PMID: 24371114 DOI: 10.7863/ultra.33.1.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Sánchez-Ferrer ML, Hernández-Martínez F, Machado-Linde F, Ferri B, Carbonel P, Nieto-Diaz A. Uterine Rupture in Twin Pregnancy with Normal Fetus and Complete Hydatidiform Mole. Gynecol Obstet Invest 2014; 77:127-33. [DOI: 10.1159/000355566] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/10/2013] [Indexed: 11/19/2022]
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Aguin E, Aguin V, Cisneros L, Aguin T, Van de Ven C, Bahado-Singh R. Does cerclage improve neonatal outcomes in a molar pregnancy and a coexistent fetus? A case report. BMC Res Notes 2012; 5:621. [PMID: 23126487 PMCID: PMC3507754 DOI: 10.1186/1756-0500-5-621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/29/2012] [Indexed: 11/21/2022] Open
Abstract
Background Complete hydatiform mole and coexistent viable fetus is very rare. The use of a cervical cerclage for cervical indications in the presence of this condition has never been reported. Although the diagnosis was made postnatal, the objective is to present a case with good neonatal outcome. Case presentation A patient presented with vaginal spotting around 23 weeks. She has a history of four preterm deliveries. Her cervix was dilated and a cerclage was placed. She presented again with PPROM around 25 weeks. She went into spontaneous preterm labor and delivered a viable fetus that is a healthy girl today. Eventually the pathology of the placenta showed a complete hydatidiform mole. Conclusion It is necessary to inform patients about the potential risks and poor outcomes of this condition. For those who desire all potential interventions, cerclage placement could be considered.
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Affiliation(s)
- Eduardo Aguin
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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Complete hydatidiform mole presenting as a placenta accreta in a twin pregnancy with a coexisting normal fetus: case report. Case Rep Obstet Gynecol 2012; 2012:405085. [PMID: 22928132 PMCID: PMC3424659 DOI: 10.1155/2012/405085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/22/2012] [Indexed: 11/30/2022] Open
Abstract
A twin pregnancy with a complete hydatidiform mole and a coexisting normal fetus (CHMF) is a rare clinical scenario, and it carries many associated pregnancy and postnatal risks. Limited numbers of case studies exist reporting an outcome of live birth, and only three prior cases report the presentation of a hydatidiform mole as a placenta previa. We report a case of CHMF with the molar component presenting antenatally as a placenta previa, which ultimately resulted in placenta accreta at the time of delivery. A live male infant was delivered at 34 weeks' gestation via planned cesarean section, and a hysterectomy was performed following unsuccessful removal of the molar component. We additionally utilized previously described methods of placing internal iliac balloons and ureteral stents prior to delivery. In such a high-risk pregnancy with a known molar previa component, these surgical preparation measures may be of benefit.
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Sánchez-Ferrer ML, Machado-Linde F, Martínez-Espejo Cerezo A, Peñalver Parres C, Ferri B, López-Expósito I, Abad L, Parrilla JJ. Management of a dichorionic twin pregnancy with a normal fetus and an androgenetic diploid complete hydatidiform mole. Fetal Diagn Ther 2012; 33:194-200. [PMID: 22832009 DOI: 10.1159/000338926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 04/18/2012] [Indexed: 11/19/2022]
Abstract
We describe a rare case of complete hydatidiform mole with twin live fetus (CHMTF) confirmed by histopathology, flow cytometry, and polymerase chain reaction techniques. No malformations were observed, fetal karyotype was normal and β-human chorionic gonadotropin levels were increased (>100,000 IU/ml). Once the patient had been informed of the risks, it was decided to continue the pregnancy, but termination of pregnancy was necessary at week 13 + 5 due to maternal complications consisting of hyperthyroidism, hypertension and vaginal bleeding, followed by persistent trophoblastic disease (PTD). Patients diagnosed with CHMTF should be informed of all known risks, including the considerable risk of PTD, which is similar to - or according to some reports - even higher than that associated with a singleton complete mole and is not increased by continuing pregnancy. Due to the low number of series published, evidence-based clinical management guidelines are lacking.
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Affiliation(s)
- María Luisa Sánchez-Ferrer
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de la Arrixaca, El Palmar, Spain.
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Moini A, Ahmadi F, Eslami B, Zafarani F. Dizygotic twin pregnancy with a complete hydatidiform mole and a coexisting viable fetus. IRANIAN JOURNAL OF RADIOLOGY 2011; 8:249-52. [PMID: 23329950 PMCID: PMC3522359 DOI: 10.5812/iranjradiol.4488] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 09/06/2010] [Accepted: 10/03/2011] [Indexed: 11/16/2022]
Abstract
Coexistence of a viable fetus with a hydatidiform mole is a rare condition and the diagnosis is very important because of the risk of developing severe complications in pregnancy. The management of these pregnancies is optional, although accurate and great care is required to find early signs of maternal or fetal complications. Hereby we report a case of dizygotic twin pregnancy with a complete mole and coexisting fetus that resulted in a live neonate.
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Affiliation(s)
- Ashraf Moini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Ahmadi
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Corresponding author: Firoozeh Ahmadi, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P O Box: 19395-4644, Tehran, Iran. Tel.: +98-2123562406, Fax: +98-2123562411, E-mail:
| | - Bita Eslami
- Research Promotion Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zafarani
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Massardier J, Golfier F, Journet D, Frappart L, Zalaquett M, Schott AM, Lenoir VT, Dupuis O, Hajri T, Raudrant D. Twin pregnancy with complete hydatidiform mole and coexistent fetus. Eur J Obstet Gynecol Reprod Biol 2009; 143:84-7. [DOI: 10.1016/j.ejogrb.2008.12.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 10/24/2008] [Accepted: 12/22/2008] [Indexed: 11/17/2022]
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Wagner SA, Keeler SM, Blank SV, Timor-Tritsch IE. Metastatic gestational trophoblastic disease following a complete hydatidiform mole coexistent with an anencephalic fetus diagnosed at 10 weeks' gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1533-1536. [PMID: 18809967 DOI: 10.7863/jum.2008.27.10.1533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Sarah A Wagner
- Division of Obstetric and Gynecologic Ultrasound, Department of Obstetrics and Gynecology, New York University Medical Center, New York, NY 10016 USA
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Twin pregnancy with a complete hydatidiform mole and co-existent live fetus: two case reports and review of the literature. Arch Gynecol Obstet 2008; 279:431-6. [DOI: 10.1007/s00404-008-0737-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 07/14/2008] [Indexed: 10/21/2022]
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Niemann I, Bolund L, Sunde L. Twin pregnancies with diploid hydatidiform mole and co-existing normal fetus may originate from one oocyte. Hum Reprod 2008; 23:2031-5. [PMID: 18556678 DOI: 10.1093/humrep/den226] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In twin pregnancies comprising a hydatidiform mole and a normal co-fetus, the ploidy of the mole is almost exclusively reported as diploid and very rarely as triploid. We aimed at understanding this unbalanced distribution of diploid and triploid moles in twin pregnancies by investigating the number of gametes involved. METHODS Using polymorphic DNA markers, we compared the alleles of seven moles with those of the normal co-fetuses and deduced the number of oocytes and spermatozoa represented in each twin pregnancy. RESULTS The genomes of all seven moles were androgenetic diploid; six moles were homozygous in all loci analyzed and one mole was heterozygous in several loci. In one homozygous mole, the paternal alleles were identical to those of the normal co-fetus in 13 non-linked informative microsatellite loci, indicating the involvement of one spermatozoon only, and thus of one oocyte only. Duplications of the paternal genome followed by abnormal cell division can explain this observation. In six moles, the paternal alleles were different from those of the normal co-fetus suggesting involvement of two (or more) spermatozoa. Overfertilization of one oocyte followed by abnormal cell division is a possibility. CONCLUSIONS It is possible that twin pregnancies comprising a diploid mole and a normal co-fetus most often derive from one single oocyte fertilized with one or more spermatozoa. This can explain why diploid moles are far more frequent than triploid moles in twin pregnancies.
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Affiliation(s)
- Isa Niemann
- Department of Clinical Genetics, University Hospital of Aarhus, 8000 Aarhus C, Denmark.
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Twin pregnancy with a complete hydatidiform mole and surviving co-existent fetus. Arch Gynecol Obstet 2008; 278:377-82. [DOI: 10.1007/s00404-008-0591-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Accepted: 01/29/2008] [Indexed: 10/22/2022]
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