A Case of Rapid Transformation from Hydatidiform Mole to Invasive Mole: The Importance of β-hCG (Human Chorionic Gonadotropin) Serum Levels in Follow-Up Evaluation

BACKGROUND: Gestational trophoblastic disease (GTD) is a spectrum of disorders consisting of premalignant (ie, complete [CHM] and partial hydatidiform moles [PHM]) and malignant conditions (ie, invasive moles, choriocarcinoma, placental site trophoblastic tumors, and epithelioid trophoblastic tumor). If GTD persists after initial treatment and has persistent elevated beta human chorionic gonadotropin (β-hCG), it is referred to as post-molar gestational trophoblastic neoplasia (pGTN). To date, there is no detailed information regarding how fast invasive moles can develop from CHM. However, the risk of developing any pGTN from CHM is rare within 1 month and is greatest in the first 12 months after evacuation, with most cases presenting within 6 months.

CASE REPORT: We present a case of a 46-year-old primigravida woman with rapid transformation of an invasive mole. In the beginning, the patient had a chief concern of a uterus size greater than the gestational dates. Laboratory evaluation showed high β-hCG serum level (>300 000 mIU/mL), and ultrasonography evaluation revealed a hydatidiform mole. Suction evacuation and curettage procedures were then performed. Pathology evaluation afterwards revealed a complete hydatidiform mole without any sign of malignancy. Twenty-two days afterwards, the patient came to the emergency room with vaginal bleeding. β-hCG serum level was high (53 969 mIU/mL), and ultrasonography examination showed the presence of fluid filling the uterine cavity. The patient was then diagnosed with GTN, and hysterectomy was chosen as the treatment of choice. After the surgery, her β-hCG serum level gradually reverted back to normal.

CONCLUSIONS: Invasive moles can develop less than 1 month after suction evacuation and curettage procedure for CHM. Serial β-hCG serum level evaluation according to the guideline should be performed to prevent late diagnosis, which could lead to the development of metastasis and worsen the prognosis.

Keywords: gestational trophoblastic disease, Hydatidiform Mole, Hydatidiform Mole, Invasive, Chorionic Gonadotropin, Follow-Up Studies, Placenta, Pregnancy, Uterine Neoplasms

Figures

Figure 1.. The USG Examination before curettage. Figure 2.. The USG Examination after curettage. Figure 3.. Macroscopic picture of complete hydatidiform mole suction evacuation and curettage procedures showed mole bubbles. Figure 4.. Microscopic image of complete hydatidiform mole showing chorialis villi experiencing hydrophilic degeneration of avascular scalloped form and accompanied by the formation of cisterns lined with proliferative cytotrophoblast cells. Figure 5.. The USG Examination after recurrence. Figure 6.. Macroscopic image of uterus with invasive mole in the fundus. Figure 7.. Microscopic image of invasive mole showing chorialis villi that are lined with hyperplastic trophoblast cells and have invaded the myometrium. The villous fibrovascular stroma is partly hydrophilic, with avascular degeneration.

Tables

Table 1.. Reported cases of invasive mole rapid transformation after curettage procedure. Table 2.. Biomarkers that have been suggested to plays a role in the transformation from hydatidiform mole to invasive mole.

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