11 May 2021
: Case report
A Rare Case of Early Transformation of Gestational Trophoblastic Neoplasia Following Molar Pregnancy
Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease
Febia Erfiandi1ABCDEFG*, Kemala Isnainiasih Mantilidewi1BCDEF, Yudi Mulyana Hidayat1BCDE, Ali Budi Harsono1CDEFG, Dodi Suardi1BCD, Siti Salima1CDEG, Andi Kurniadi1CDEG, Indah P. Islami1DEF, Hasrayati Agustina2DEF, Birgitta Maria Dewayani2DEF, Aisyah Shofiatun Nisa1E, Huda Toriq1EDOI: 10.12659/AJCR.930789
Am J Case Rep 2021; 22:e930789
Table 3. Diagnostic features of hydatidiform mole [13].
Diagnostic feature | CHM | VECHM | PHM |
---|---|---|---|
Clinical presentation | Vaginal bleeding in second trimester (average 16 weeks). Excessive uterine size, hyperemesis, toxemia, preeclampsia or hyperthyroidism | Missed Abortion (6.5 to 12 weeks of gestation) | Vaginal bleeding, missed or incomplete abortion in late first or early second trimester |
Pretreatment hCG (mIU/mL) | Elevated (>100×10) in >43% of cases | Normal or elevated (<100×10) | Normal or elevated (<100×10 in >93% of cases) |
Ultrasound | Snowstorm pattern without fetus formation | – | Focal cystic change with fetus formation |
Chorionic villi | Diffuse enlargement, round to oval shapes | Normal size, polypoid or cauliflower shapes | Mild, with syncytiotrophoblast knuckles |
Trophoblastic hyperplasia | Marked, often circumferential with intervillous trophoblast bridging | Mild, often on villous tips | Mild, with syncytiotrophoblast knuckles |
Cytological atypia | Marked | Mild to moderate | Limited to mild |
Villous stroma | Marked edema with frequent cistern formation and trophoblastic inclusions. Absence of vasculature and nucleated RBCs | Cellular and myxoid with prominent karyorrhexis fetal capillaries may be present | Occasional cistern formation Round to oval trophoblastic pseudo-inclusion Presence of vasculature and nucleated RBCs (not always evident) |
p57 Immunostain | Absence of nuclear staining in cytotrophoblast and villous stromal cells | Absence of nuclear staining in cytotrophoblast and villous stromal cells | Presence of nuclear staining in cytotrophoblast and villous stromal cells |
DNA genotyping | Diploid diandric (paternal-only) genome | Diploid diandric (paternal-only) genome | Triploid diandric-monogynic genome |
CHM – complete hydatidiform mole; VECHM – very early complete hydatidiform mole; PHM – partial hydatidiform mole; RBC – red blood cell. |