Fact-sheet: Hydatidiform mole


Updated on 09/30/2019 at 4:25 PM

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Definition

Gestational trophoblastic disease
Spectrum of conditions ranging from benign precancerous lesions (partial or complete Hydatidiform mole) to malignant tumors (referred to as gestational trophoblastic tumors), occurring after a molar or nonmolar pregnancy:
- Invasive mole
- Choriocarcinoma
- Placental site tumors
- Various trophoblastic tumors
• Incidence:
1/1000 for partial Hydatidiform mole and 3/1000 for complete Hydatidiform mole, in Western countries
16% of complete Hydatidiform moles progress to a malignant form vs 0.5% for partial hydatidiform moles.
2 to 202/100,000 for choriocarcinomas
• In women of childbearing age
• Pathophysiology:
- Fertilized egg --> trophoblastic cells (provide nutrients + form the fetal placenta)
- Gestational trophoblastic tumors = malignant abnormal proliferation of placental trophoblasts

Clinical features

When should the diagnosis be considered?

- Amenorrhea, pelvic mass, unexplained first-trimester metrorrhagia

- Discovery of pregnancy

Laboratory findings

Biological criteria for trophoblastic tumor:

- Plateau curve of hCG values over 4 consecutive assays, over 3 weeks

- Increase of at least 10% in hCG value over 3 assays over 2 weeks

- Persistent elevation of hCG, 6 months after evacuation of a mole

Ultrasound

In case of suspected Hydatidiform mole, this is the first-line examination

Demonstrates a multi-cystic, hypervascularized intrauterine mass syndrome

CT

Chest-abdomen-pelvis CT: extension workup (search for secondary pulmonary lesions +++, which are associated with an increased risk of other secondary sites: hepatic, cerebral)

--> hypervascularized secondary lesions.

MRI

Gestational trophoblastic disease:

Pelvic MRI:

- Local and loco-regional extension

- Protocol: T2 SE in 3 planes, axial/sagittal T1 FS, diffusion-weighted imaging, axial/sagittal T1 with dynamic gadolinium injection

- Findings include: an endocavitary mass with heterogeneous T2 hyperintensity, hemorrhagic areas, microcysts and a honeycomb appearance, assessment of myometrial involvement, evaluation of junctional zone invasion

- Bilateral ovarian luteal cysts frequently associated

Brain MRI: (preferably, otherwise brain CT)

- Distant extension workup

- Search for secondary lesions, hypervascularized, hemorrhagic

Management

- Uterine curettage after ultrasound diagnosis of complete or partial mole - Then regular follow-up with hCG monitoring, gynecological clinical examination, pelvic ultrasound - If hCG rises again or plateaus: suspect an evolving, invasive form: perform chest-abdomen-pelvis CT and brain imaging, pelvic MRI - Validation of management at the reference center for trophoblastic tumors - FIGO classification and FIGO/WHO prognostic score - Malignant forms require initiation of chemotherapy