questions 3

Hydatidiform Mole

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Topic updated on 07/17/16 6:09am

Snap Shot
  • A 24-year-old Asian female presents with vaginal bleeding and abdominal pain in her 10th week of pregnancy. Ultrasound of the uterus reveals a snowstorm appearance and absence of the fetus
Introduction
  • Benign placental tumor with cystic swelling of chorionic villi and trophoblastic proliferation
  • Epidemiology
    • more common in Asian women
  • Can be complete or partial
    • complete mole 
      • most common type
      • 46, XX
        • empty egg with entry of 2 sperm
        • 46 paternal chromosomes
      • no fetus
    • partial mole
      • 69 XXY, XXX 
        • 46 paternal chromosomes + 23 maternal chromosomes
      • fetus present
Presentation
  • Symptoms
    • abnormal/painless vaginal bleeding
      • typically in 4th-5th month
    • vomiting
  • Physical exam
    • abnormally enlarged uterus for gestational age
Evaluation
  • Serology
    • ↑ β-hCG
      • higher in complete mole than incomplete mole
  • Ultrasound
    • complete moles classically have "snowstorm" appearance with no fetus
  • Gross pathology
    • "honeycombed uterus" or "cluster of grapes" gross appearance
Treatment
  • Surgical
    • dilation and curettage
      • monitor β-hCG following treatment
        • should fall to zero
  • Medical
    • methotrexate
Prognosis, Prevention, and Complications
  • Choriocarcinoma
    • may progress to choriocarcinoma
    • more common in complete moles
  • Uterine rupture
    • moles can lead to uterine rupture



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Qbank (3 Questions)

TAG
(M1.RP.27) A 21-year-old Korean female in her 12th week of pregnancy presents with abdominal pain, vaginal bleeding, and excessive vomiting. A transvaginal ultrasound shows what appears to look like a cluster of grapes (Figure A). Serology demonstrates a significantly increased beta-HCG, and physical exam reveals an abnormally large uterus for the gestational age of the pregnancy. Subsequent genetic analysis reveals a karyotype of 46,XX. Which of the following is the most likely pathogenesis? Topic Review Topic
FIGURES: A          

1. Ovum fertilized by one sperm and implanted in fallopian tubes
2. Ovum fertilized by one sperm and implanted in the uterus
3. Ovum fertilized by two sperm
4. Ovum fertilized by one sperm with duplication of the sperm
5. Empty ovum feritilized by two sperm

PREFERRED RESPONSE ▶
TAG
(M1.RP.46) A 29-year-old female reports having a positive home pregnancy test result 9 weeks ago. She presents today with vaginal bleeding and complains of recent onset abdominal pain. Ultrasound of the patient’s uterus is included as Image A. Subsequent histologic analysis (Image B) reveals regions of both normal as well as enlarged trophoblastic villi. Which of the following is the most likely karyotype associated with this pregnancy? Topic Review Topic
FIGURES: A   B        

1. 46 XX, both of maternal origin
2. 46 XY, both of paternal origin
3. 69 XXY
4. 47 XXY
5. 45 XO

PREFERRED RESPONSE ▶
TAG
(M1.RP.73) A 31-year-old Asian woman presents with painless vaginal bleeding late in the first trimester of her pregnancy. She has had no prenatal care up to this point. Serum HCG levels are elevated much more than expected. You obtain an abdominal ultrasound, and observed the findings in figure A.

Which of the following is the most likely karyotype associated with this pregnancy? Topic Review Topic
FIGURES: A          

1. 45XO
2. 47XYY
3. 46XX
4. 69XXX
5. 69XYY

PREFERRED RESPONSE ▶


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