Molar Pregnancy: A Case Study

Objectives

Gestational Trophoblastic Disease (GTD)

Hydatidiform Moles

Pathophysiology of Hydatidiform Mole

Typical Presentation of Complete Moles

Presentation of Partial Moles

Invasive Moles

Choriocarcinoma

Choriocarcinoma (cont’d)

Placental Site Trophoblastic Tumor 

Diagnosis

Ultrasound

Classic Ultrasound Images

Human Chorionic Gonadotropin

Phantom hCG Levels/False Positive Results

Pathologic Diagnosis

Case Study

Patient HistoryOB Hx:  G2P0010; SAB 3/2011

Objective Info

The exam was WNL, with the exception of an  8‐9 week uterus

Initial Ultrasound

Work Up for Suspected Mole

Twin Pregnancy

Plan 

D&C 

Pathology ResultsFinal pathology showed Complete Mole: 

Classic Ultrasound Images

Next Step for this Patient

Repeat HCG Levels

What is next?

Testing with Dx of GTN

Results of Pt’s Testing

Staging for GTN

Scoring System for GTNRisk Factor 0 1 2 4

Age (years) <= 39 >39 ‐ ‐

Antecedent pregnancy

Mole Abortion Term ‐

Pregnancy event to treatment interval (months)

<4 4‐6 7‐12 >12

Pretreatment hCG,mIU/mL

<10,000 10,000‐100,000

100,000‐1,000,000

>1,000,000

Largest tumor mass,including uterus (cm)

<3 3‐4 >=5 ‐

Site of metastasis ‐ Spleen,kidney

GI tract Brain, liver

No. of metastasis ‐ 1‐4 5‐8 >8

Previous failed chomotherapy

‐ ‐ Single drug >=2 drugs

Total score is obtained by adding individual scores for each prognostic factor. Low risk <7, High risk >=7. 

Case Patient’s Treatment

Treatment for Low Risk GTN

Treatment for High Risk GTN

Follow Up after Chemotherapy

Future Pregnancies?

Summary

References

Questions???