Partial hydatidiform mole

Case contributed by Dr Hala Maher

Presentation

Primigravida with brownish discharge during the first trimester for a check-up.

Patient Data

Age: 30 years
Gender: Female

Pelvic Ultrasound

Ultrasound

Pelvic ultrasound shows a distended uterine cavity by the enlarged placenta that showing cystic changes (giving a picture of snowstorm appearance) along with an empty amniotic sac (gestational sac) is seen has been compressed and displaced by it. Also, color Doppler interrogation was done and showing slightly increased vascularity.

Intra-operative ultrasound guided uterine curettage

Ultrasound

Uterine curettage procedure of the case with intraoperative ultrasound guidance and complete evacuation of the uterine cavity.

Gross pathology of the uterine contents.

Pathology

Picture of the uterine contents after curettage demonstrating the grape-like appearance and vesicular cysts of the hydatidiform mole.

Case Discussion

Ultrasound is the standard imaging modality for identifying molar pregnancy.

Classically, a 'snowstorm pattern' is resulting from the presence of a complex vesicular intrauterine mass containing many 'grape-like' cysts.

Adding the result of laboratory Studies and in this case, BHCG was 225,000 mIU/mL( BHCG levels greater than 100,000 mIU/mL indicate exuberant trophoblastic growth and raise also the suspicion for a molar pregnancy). Also, dilatation and curettage has been done for our case and the diagnosis confirmed.

Hydatidiform moles should be regarded as premalignant lesions because 15-20% of complete hydatidiform moles (CHMs) and 1% of partial hydatidiform moles (PHMs) undergo malignant transformation into invasive moles and choriocarcinomas.

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