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

We report a fetal autopsy case that was diagnosed with a mole coexistent with a live fetus at an early gestation and finally showed coexisting true hermaphroditism of 46,XX/46,XY mosaicism and partial hydatidiform mole, developing metastatic gestational trophoblastic tumors in the lungs of the mother. A 23-year-old Japanese female had a mole coexistent with a fetus and showed a high chorionic gonadotropin titer in urine and serum at 10 weeks of gestation. The fetus was interrupted for gestational toxicosis and genital bleeding at 20 weeks of gestation. A chromosome analysis demonstrated 46,XX and 46,XY mosaicism in both umbilical cord blood and mole samples. Intrapelvic organs contained a testis in the one gonad, and an ovotestis in the other gonad microscopically. The testis had seminiferous tubules containing primitive germ cells, immature Sertoli cells, and cytomegalic Leydig cells. The ovary in the ovotestis had numerous primitive germ cells and a few stromal cells. Cortical cytomegaly and medullary neuroblastoma in situ were seen in the adrenals. The placenta showed focal villous hydrops and focal trophoblast hyperplasia. The patient presented multiple metastatic pulmonary tumors at 1 month after the interruption, and was treated with chemotherapy for the clinical diagnosis of gestational trophoblastic tumor metastases. She responded well and is alive without any symptoms.
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PMID:Coexisting true hermaphroditism and partial hydatidiform mole developing metastatic gestational trophoblastic tumors. A case report. 1244 83

Human chorionic gonadotropin (hCG) is a glycoprotein hormone that has structural similarity to TSH. At the time of the peak hCG levels in normal pregnancy, serum TSH levels fall and bear a mirror image to the hCG peak. This reduction in TSH suggests that hCG causes an increased secretion of T4 and T3. Women with hyperemisis gravidarum often have high hCG levels that cause transient hyperthyroidsm. In the vast majority of such patients, there will be spontaneous remission of the increased thyroid function when the vomiting stops in several weeks. When there are clinical features of hyperthyroidism, it is be reasonable to treat with antithyroid drugs or a beta-adrenergic blocker, but treatment is rarely required beyond 22 weeks of gestation. Hyperthyroidism or increased thyroid function has been reported in many patients with trophoblastic tumors, either hydatiditform mole or choriocarcinoma. The diagnosis of hydatidiform mole is made by ultrasonography that shows a 'snowstorm' appearance without a fetus. Hydatidiform moles secrete large amounts of hCG proportional to the mass of the tumor. The development of hyperthyroidism requires hCG levels of >200 U/ml that are sustained for several weeks. Removal of the mole cures the hyperthyroidism. There have been many case reports of hyperthyroidism in women with choriocarcinoma and high hCG levels. The principal therapy is chemotherapy, usually given at a specialized center. With effective chemotherapy, long-term survival exceeds 95%. A unique family with recurrent gestational hyperthyroidism associated with hyperemesis gravidarum was found to have a mutation in the extracellular domain of the TSH receptor that made it responsive to normal levels of hCG.
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PMID:Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. 1515 39

A case of a 56-year-old woman with a mole pregnancy and a human chorionic gonadotropin (HCG)-induced thyreotoxicosis is presented. A proper diagnosis was only made after a period of patient and doctor's delay. After performing a hysterectomy, the HCG quickly normalized. Thyroid function normalized with thiamazol treatment. It is well known that older women have a higher risk to develop gestational trophoblastic disease (GTD). Furthermore, the chance of persistent trophoblastic disease is increased in this population. The literature on risk factors for developing persistent GTD and the possibilities for treatment in older patients is reviewed.
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PMID:A case of a hydatidiform mole in a 56-year-old woman. 1567 Mar 12

Partial or complete hydatidiform mole (HM) affects approximately 1 in 500 to 1,000 pregnancies. Previous small series suggest that histopathologic diagnosis of HM may be difficult in tubal ectopic pregnancies. The histopathology database of a regional Trophoblastic Disease Unit was searched to identify cases with a referral diagnosis of tubal HM, and the histopathologic findings were reviewed. During the study period (1986-2004 inclusive), there were 132 cases. After central review by specialist histopathologists, the final diagnosis was ectopic partial mole in two, ectopic complete mole in five, and ectopic hydatidiform mole (not otherwise specified) in one. The final diagnosis of definite hydatidiform mole was made in eight (6%) cases, significantly less than in referred uterine curettage specimens, in which approximately 90% have a confirmatory diagnosis of HM (Z = 12.9; p < 0.0001). No cases in this series developed persistent gestational trophoblastic disease, the human chorionic gonadotropin concentration spontaneously returning to normal. Ectopic pregnancies, where managed surgically, should be submitted for histopathologic examination; however, the pathologist should be aware that the degree of extravillus trophoblastic proliferation may appear more florid compared with evacuated uterine products of conception. Molar pregnancy should only be diagnosed when strict criteria regarding morphologic abnormalities previously described in uterine evacuation material are applied.
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PMID:Overdiagnosis of complete and partial hydatidiform mole in tubal ectopic pregnancies. 1596 2

A 38-year-old woman had a 4-week history of vaginal bleeding, heat intolerance and palpitations. Levels of beta-human chorionic gonadotropin and thyroid hormones were abnormally high. After ultrasound diagnosis of a molar pregnancy, evacuation of the mole was planned with preoperative treatment involving the use of antithyroid drugs and plasmapheresis. Plasmapheresis was used to prepare for surgery in our patient who needed more rapid hormonal control. In conclusion, early diagnosis of molar pregnancy results in decreased incidence of significant complications related to hyperthyroidism.
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PMID:Severe hyperthyroidism requiring therapeutic plasmapheresis in a patient with hydatidiform mole. 1686 52

The incidence of ovarian malignancies during gestation ranges from 1 in 8000 to 1 in 20,000 deliveries. Ovarian malignancies that produce human chorionic gonadotropin (hCG) are limited to germ cell tumors, of which dysgerminoma is the most frequent (45%) malignant type encountered in pregnant patients, the others being ovarian choriocarcinoma and mixed germ cell tumors (Boulay and Podczaski, 1998). In women of childbearing age, it is hard to distinguish between metastatic choriocarcinoma on a complete mole and primary ovarian choriocarcinoma. Treatment is based on adnexectomy followed by chemotherapy. Given the extreme rarity of these tumors, the long-term prognosis is difficult to establish. Had the diagnosis for our patient been made during pregnancy, the therapeutic approach would have been discussed in terms of gestational age. In the last trimester, we could have suggested cesarean section followed by adnexectomy, and then chemotherapy. In the second-trimester, chemotherapy could have been discussed, although the fetal toxicity of cisplatin chemotherapy is not firmly defined (Ferrandina et al., 2005). This treatment is an alternative to termination of pregnancy. We retrospectively studied maternal serum biochemistry so as to assess the possibility of a diagnosis of ovarian choriocarcinoma at the time of maternal serum screening for Down syndrome.
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PMID:Could ovarian choriocarcinoma be detected by maternal serum screening for Down syndrome? 1753 25

Glycodelin (Gd) is a major reproductive glycoprotein and a mediator for immunomodulatory effects directed to cellular, humoral, and innate immunity. Human pregnancy depends on a diversity of physiological processes including modulation of the maternal immunosystem. We evaluated the expression of Gd protein and mRNA in first trimester decidual tissue of normal pregnancies and spontaneous abortion and hydatidiform moles. Furthermore, in vitro experiments on endometrial cancer cells to analyze the effect of human chorionic gonadotropin (hCG) on Gd regulation were performed. In decidual tissue of abortion patients, Gd expression was significantly decreased compared with normal gestation, which was confirmed by in situ hybridization. In mole pregnancy, an upregulation of Gd in the first 8 weeks of pregnancy was present. Gd is a main product of decidual tissue in the first trimester of human pregnancy. Reduced Gd expression in abortive pregnancy could lead to an increased activation of the maternal immunosystem, thus causing rejection of the developing fetus. Moreover, Gd expression in endometrial cancer cells in vitro could be stimulated by addition of hCG. Therefore, we speculate that hCG could be one of the factors regulating Gd expression because hCG is downregulated in women with abortion and upregulated in mole pregnancy. In addition, we found a positive feedback loop in Gd and hCG expression in human pregnancy.
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PMID:Glycodelin protein and mRNA is downregulated in human first trimester abortion and partially upregulated in mole pregnancy. 1825 18

We report a well-documented case of a 28-year-old woman, gravida 3, para 1, undergoing termination at 22 weeks for fetal congenital malformations with concurrent partial hydatidiform mole and choriocarcinoma. A fetal ultrasound showed spina bifida, and an elective termination was performed. One month later, the patient presented with vaginal bleeding, cough, and shortness of breath. A chest computed tomographic scan revealed multiple lung nodules. A pelvic ultrasound was consistent with retained products of conception, and endometrial sampling showed an atypical trophoblastic proliferation consistent with choriocarcinoma. The serum beta-human chorionic gonadotropin level was greater than 100,000 IU/mL. The placental pathology reviewed at our institution showed microscopic foci of choriocarcinoma arising in a partial hydatidiform mole. Flow cytometry performed on paraffin-embedded tissue showed a triploid peak, which confirmed the partial molar nature of this gestation. Immunohistochemistry showed nuclear p57 expression in the partial molar villous trophoblastic and stromal cells, but not in the severely atypical trophoblasts, further supporting the diagnosis of intraplacental choriocarcinoma distinct from the partial mole. Although the molecular pathogenesis remains to be elucidated, this report provides additional evidence that choriocarcinoma may arise directly from partial molar gestations. Moreover, it emphasizes the importance of thorough sampling of placentas with partial hydatidiform mole in search of minute foci of choriocarcinoma because they might represent a potential source of metastatic gestational trophoblastic disease.
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PMID:Intraplacental choriocarcinoma arising in a second trimester placenta with partial hydatidiform mole. 1831 16

Clinical thyrotoxicosis is rare in molar pregnancy and has yet to be reported in a patient with a partial mole. Human chorionic gonadotropin (hCG), which has thyrotropic activity, is believed to be responsible for hyperthyroidism of gestational trophoblastic activity and hyperemesis gravidarum. We report the first case of hyperthyroidism presenting as thyroid storm in a partial molar pregnancy. Normal thyroid function returned after the partial mole was evacuated, and the biochemical improvement correlated with declining hCG levels. This case highlights the importance of including partial mole in the differential of hCG-mediated hyperthyroidism.
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PMID:Thyroid storm caused by a partial hydatidiform mole. 1835 22

The hydatiform mole is a relatively rare pregnancy complication, but with potential to evolve to forms which need systemic treatment and can be a threat to life. There are two histopathological and clinical entities under the name of hydatiform mole: the partial and the complete mole. The differences between the two forms are important due to risk of evolution to persistent forms, which is higher for the complete moles. The diagnosis, treatment and follow-up of hydatiform mole have been under important changes in the last years. The number of asymptomatic patients has increased, due to the use of ultrasonography at the onset of pregnancy. The use of medication that induces uterine contractions must be avoided, and vacuum aspiration should be used. Soon after emptying the mole, a hormonal contraceptive method should be prescribed. Follow-up should be based on weekly serial dosages of chorionic gonadotropin. It is important that the method employed detects all the forms of chorionic gonadotropins (intact molecule, with hyper glycol, free beta subunit, and central fragment beta subunit).
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PMID:[Hydatidiform mole and gestational trophoblastic disease]. 1940 15


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