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Query: UMLS:C0027960 (mole)
 21,279 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recent studies suggest that a partial mole with a triploid karyotype has little tendency to invade and metastasize and usually requires no therapy other than evacuation. This report describes three patients with a mole of normal diploid karyotype coexisting with a living fetus. Each patient had persistent elevation of human chorionic gonadotropin. Two patients required chemotherapy; one of these had invasive mole. The partial mole with normal diploid karyotype is a distinct clinical entity with the potential for malignant sequelae. The possibility of twin gestation cannot be excluded.
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PMID:Partial hydatidiform mole with diploid karyotype: report of three cases. 650 34

The recovery of the ovarian response to gonadotropin stimulation after molar abortion was investigated in relation to the serum human chorionic gonadotropin (hCG) level. Thirteen women with an aborted mole were given 225 IU of human menopausal gonadotropin (hMG) per day for 3 consecutive days, and their serum levels of estradiol (E2) were determined by radioimmunoassay on days 1, 3, 5, and 7 after hMG administration. Women with serum hCG levels of less than 200 mIU/ml exhibited a normal increase in serum E2 levels in response to hMG, whereas women with serum hCG levels of 2000 mIU/ml or more did not show any change after hMG administration. These findings suggest that a serum level of hCG in excess of 2000 mIU/ml prevents normal ovarian E2 responsiveness to exogenous gonadotropin stimulation.
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PMID:Restoration of the ovarian response to gonadotropins in patients after molar abortion. 679 52

The disappearance time of serum human chorionic gonadotropin (hCG) after the evacuation of hydatidiform mole, partial mole, and hydropic degeneration was investigated. A statistically significant difference existed between the disappearance time of serum hCG after the evacuation of hydatidiform mole as compared with partial mole and hydropic degeneration. The average disappearance time of serum hCG after hydatidiform mole was 99.3 days, after partial mole 58.9 days, and after hydropic degeneration 50.7 days. It is not recommended to start chemotherapy for persistent trophoblastic disease before 100 days after the evacuation of hydatidiform mole, provided there is a steady downward course of the serum hCG level. It is advised to submit cases of supposed hydatidiform and partial moles to a tissue committee for a second opinion.
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PMID:Plasma human chorionic gonadotropin disappearance in hydatidiform mole: a central registry report from the Netherlands. 688 25

Having delineated the complete and the partial hydatidiform moles as 2 separate entities on the basis or morphology and cytogenetics, the authors studied 201 molar pregnancies at the Magee-Womens Hospital in an attempt to characterize the clinicopathologic profile of the partial mole syndrome. This was done mainly by comparison and contrast with the established and more familiar syndrome of the classic complete mole. The partial mole syndrome displays most of the pathologic and clinical features of the classic mole and seems to represent a milder, dilute version of the latter. This applies to placental morphology, to the fate of the embryo/fetus, and to human chorionic gonadotropin (hCG) levels as well as to the incidence and severity of clinically persistent trophoblastic disease. Preeclampsia can be equally severe in both syndromes, but tends to occur later in patients with partial mole. No metastatic disease was encountered in association with partial moles and no case of overt choriocarcinoma has yet been described. The occurrence of trophoblastic disease (as determined by postoperative hCG titers) following partial moles requires further inquiry, including study of the pathology of the underlying lesion(s), which remain virtually unexplored.
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PMID:The clinicopathologic profile of the partial hydatidiform mole. 707 Jul 31

A total of 171 cases of molar pregnancy were followed by serial radioimmunoassay of the beta subunit of human chorionic gonadotropin (hCG-beta) over a 4-year period. The incidence over the study interval was 1:1,202 pregnancies in the province. In 120 women with intact uteri and measurable plasma levels of hCG-beta at the initiation of follow-up, the hormone remained detectable for up to 219 days (between 31 and 32 weeks) following evacuation, with 50% of patients remaining positive at 63 days (between 8 and 9 weeks). In five women undergoing hysterectomy, the hormone remained detectable for up to 112 days (between 15 and 16 weeks) postoperatively. In 92% of the cases, hCG-beta regressed to negative without chemotherapy. The prolonged presence of hCG in plasma after evacuation of the mole, regardless of the presence or absence of the uterus, points to persistence of molar tissue and its gradual rejection from uterine and extrauterine sites as a common phenomenon in the natural history of the uncomplicated postmolar course of this disease.
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PMID:Molar pregnancy in British Columbia: estimated incidence and postevacuation regression patterns of the beta subunit of human chorionic gonadotropin. 746 1

An immunohistochemical study analyzing distributions of beta-subunit human chorionic gonadotropin (beta HCG), human placental lactogen (HPL), placental alkaline phosphatase (PLAP), and monoclonal anti-cytokeratin (PKK1) was undertaken to determine whether the reactivity of these antigens might assist in the differential diagnosis of molar and non-molar hydropic placentas. A total of 16 complete hydatidiform moles, 15 partial hydatidiform moles, 12 hydropic abortuses and 39 non-hydropic placentas with gestational age ranging from 4 to 40 weeks was examined. In both the complete and partial moles, many syncytiotrophoblasts stained for beta HCG, HPL, PLAP and PKK1 although the staining intensity of beta HCG in the partial moles was weak compared with the complete moles. The staining patterns in the hydropic abortuses were almost the same as those in the normal first trimester placentas and had no distinct features from the partial moles. Trophoblastic hyperplasia is an essential feature in differentiating partial moles from hydropic abortuses. With regard to the immunostaining patterns of these antibodies, there was no significant difference to enable delineation between partial and complete moles, or between a hydropic abortus and a partial mole. Monoclonal anti-cytokeratin was most sensitive for trophoblasts, but less specific for intermediate trophoblasts than HPL. Although an immunohistochemical study using antibodies against beta HCG, HPL, PLAP and PKK1 is very useful for characterizing various trophoblasts, it is considered that an immunohistochemical study may not be a suitable tool for the differential diagnosis of molar and non-molar hydropic placentas.
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PMID:Immunohistochemistry of molar and non-molar placentas with special reference to their differential diagnosis. 750 73

The estimated incidence of twin pregnancy consisting of hydatidiform mole and a coexisting fetus is 1 per 22,000-100,000 pregnancies. Since 1965, nine patients with this entity have been treated at the New England Trophoblastic Disease Center (NETDC), Boston. One patient had a partial hydatidiform mole coexisting with a normal placenta and fetus. The other eight patients had twin pregnancies with a complete hydatidiform mole (CHM) and coexisting fetus. We compared the clinical outcomes in these 8 patients and 14 additional published case reports of multiple gestations composed of CHM and coexisting fetuses with a group of 71 patients with singleton CHM treated at NETDC. Twelve of the 22 patients (55%) with CHM and coexisting fetuses developed persistent gestational trophoblastic tumor, requiring chemotherapy. Five of these patients developed metastases requiring multiple cycles of chemotherapy to achieve remission. The presenting symptoms of multiple conception with CHM and coexisting fetuses were similar to those in patients with a singleton conception and complete mole. However, as compared to singleton CHM, patients having a multiple conception with CHM and coexisting fetuses were diagnosed at a later gestational age, had higher preevacuation beta-human chorionic gonadotropin levels and had a greater propensity to develop persistent tumor. These data indicate that patients with multiple conceptions consisting of CHM and coexisting fetuses are at high risk of developing persistent gestational trophoblastic tumor.
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PMID:Clinical features of multiple conception with partial or complete molar pregnancy and coexisting fetuses. 803 69

Diagnosis of molar pregnancy relies on serum and urine human chorionic gonadotropin estimations in addition to characteristic appearances on histology. Approximately 92% of hydatidiform moles resolve spontaneously after evacuation, and with careful human chorionic gonadotropin follow-up, the remainder can be successfully treated with a minimum of toxicity. Non-post-mole gestational choriocarcinoma is also highly curable with modern chemotherapy, and in the rare cases when drug resistance develops, surgery can be an effective salvage treatment. In cases when doubt exists as to whether a patient has a true gestational tumor or a human chorionic gonadotropin-producing carcinoma, the origin of the tumor can sometimes be determined by DNA analysis. This determination can help to avoid inappropriate chemotherapy for patients with nongestational tumors.
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PMID:Current approaches to diagnosis and treatment of gestational trophoblastic disease. 838 Oct 37

Gestational trophoblastic disease is a term that describes a group of tumors that share several characteristics as follows: (1) they arise in fetal chorion, (2) they produce human chorionic gonadotropin (hCG), and (3) they respond extremely well to chemotherapy. Although rare, they have received a disproportionate amount of attention because they were the first metastatic solid tumor to be cured using chemotherapy. Also, hCG was the first reliable tumor marker. Finally, because they arise in fetal tissue, they have the potential for a strong immune response against paternal antigens in the tumor. This potential for immunologic rejection was thought initially to explain the success of chemotherapy in this disease. The early detection of gestational trophoblastic disease is successful in patients who have had a hydatidiform mole as the pregnancy event that begins the process but unsuccessful in the early detection of the development of choriocarcinoma after a normal term delivery, abortion (spontaneous or elective), or ectopic pregnancy. Surveillance after evacuation of a molar pregnancy (whether complete or a partial mole) consists of regular evaluation of hCG production and the detection of metastatic disease. However, the development of gestational choriocarcinoma after term pregnancy or an abortion (no molar tissue can develop as a consequence of these pregnancies) is detectable only by signs or symptoms of metastatic disease in any of the many organs to which this tissue can spread. Unlike most staging classifications in gynecologic cancers, which are based on histologic findings and tumor location, the classification used in gestational trophoblastic disease stresses other features that are more useful for treatment selection. Both the National Institutes of Health and the World Health Organization classifications emphasize the importance of recognizing factors that predict the likelihood of a tumor responding to chemotherapy. Currently available treatment can cure all patients except those who are in the very high-risk group, which usually is characterized by metastasis to the brain or liver or a history of prior chemotherapy. Even in this category, approximately 80% of patients are curable.
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PMID:Diagnosis and management of gestational trophoblastic disease. 838 9

Recent trends toward early pregnancy ultrasound have led to evacuation of complete hydatidiform moles at a stage before the development of diffuse trophoblast hyperplasia and villous cavitation. Absence of these recognized diagnostic criteria can lead to misdiagnosis and subsequent trophoblastic neoplasia. The authors identified a case of very early complete hydatidiform mole (VECM) on review of a previous curettage specimen when the patient presented 4 weeks later with increasing human chorionic gonadotropin (HCC) titers and the typical histological features of complete mole on a subsequent curettage. DNA studies on this index case and three subsequent similar specimens confirmed the diagnosis of complete hydatidiform mole using polymerase chain reaction (PCR) amplification of eight microsatellite markers on microdissected maternal and villous tissue. VECM were compared with spontaneous abortions and elective terminations of a similar gestational age to develop diagnostic criteria. Five cardinal diagnostic features were identified: redundant bulbous terminal villi, hypercellular villous stroma, a labyrinthine network of vinous stromal canaliculi, focal cytotrophoblast and syncytiotrophoblast hyperplasia on both villi and the undersurface of the chorionic plate, and enlarged hyperchromatic implantation site trophoblast.
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PMID:Very early complete hydatidiform mole. 869 16


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