Term twin pregnancy with hydatidiform mole and a normal fetus

A term twin pregnancy with a complete hydatidiform mole and a normal live fetus is reported. Received: Mai 1998 / Accepted: 22 October 1998     

Complete hydatidiform mole coexisting with a live fetus

The co-existence of a hydatidiform mole with a living fetus is a rare phenomenon. The condition is a dilemma with respect to the diagnosis and management of associated maternal (a risk of maternal complications, such as preeclampsia, hyperthyrodism, and a risk of malignancy) and fetal (elevated risk of spontaneous abortion, neonatal thyrotoxicosis) complications. A 27-year-old woman was referred to our hospital with a diagnosis of hydatidiform mole and live fetus. The pregnancy was unremarkable except for the complaints of excessive nausea and vomiting. Successive ultrasound examinations demonstrated a normally growing live fetus (14 weeks) alongside a normal placenta and an additional intrauterine echogenic mass with features of hydatidiform mole. Genetic amniocentesis at 18 weeks' of gestation showed normal diploid fetal karyotype. At 20 weeks of pregnancy, a control prenatal visit revealed intrauterine fetal death. The follow-up period for two years was unremarkable. In the case of a normal fetal karyotype and the absence of serious signs of maternal pathology, waiting until fetal viability is achieved can justifiably be proposed, however there is still a risk of prenatal complications such as intrauterine death.     

葡萄胎表皮生长因子受体表达与滋养细胞增生和葡萄胎恶变的相关性研究

目的 探讨表皮生长因子受体（EGFR）表达、滋养细胞增生与葡萄胎恶变的关系。方法 检测石蜡包埋的135例葡萄胎和13例正常早孕绒毛标本,常规组织切片病理观察滋养细胞增生程度,免疫组化法检测EGFR表达情况。结果EGFR在所有类型的滋养细胞和正常绒毛中表达。全部合体滋养层细胞的EGFR为强阳性。在细胞滋养层细胞,非恶变组葡萄胎EGFR阳性表达率与正常绒毛的阳性表达率无显著差异（P>0.05）,恶变组葡萄胎EGFR的阳性表达率显著低于正常绒毛和无恶变组葡萄胎（P<0.05,P<0.01）;轻度滋养细胞增生者EGFR阳性表达率显著强于中度及重度滋养细胞增生者（P<0.01,P<0.01）,中度与重度滋养细胞增生者EGFR表达无显著性差异（P>0.05）。结论 恶变组葡萄胎EGFR的表达弱于非恶变组葡萄胎,滋养细胞增生程度重者EGFR表达减少,EGFR表达降低在葡萄胎恶变过程中可能有重要的生物学意义。     

Multiple metastatic gestational trophoblastic disease after a twin pregnancy with complete hydatidiform mole and coexisting fetus,following assisted reproductive technology: Case report and literature review

Objective

Twin pregnancy with complete hydatidiform mole and coexisting fetus (CHMCF) is rare and associated with severe complications during pregnancy and subsequent gestational trophoblastic disease (GTD). We encountered a case of multiple metastatic GTD after a twin pregnancy with CHMCF, following conventional in vitro fertilization (IVF). Only one case of metastatic GTD after CHMCF due to assisted reproductive technology (ART) has been reported. Here, we present the clinical course and reveal the clinical features of CHMCF after ART through a literature review.

短串联重复序列诊断完全性葡萄胎与胎儿共存一例报道及文献复习

目的 检测1例罕见的完全性葡萄胎与胎儿共存病例的病理及亲本来源,探讨其诊断及鉴别诊断方法.方法 对1例胎儿与葡萄胎共存病例的葡萄胎组织及胎儿、胎盘组织进行病理检查及染色体核型分析,同时检测双亲、胎儿及葡萄胎基因组DNA的5个短串联重复序列(short tandem repeat,STR)位点(D4S2460、D18S488、D21S2039、DXS1205和DYS219),确定其亲本来源.结果(1)病例简介:孕妇27岁,妊娠20周血清学筛查提示神经管缺陷高风险,B型超声检查胎儿未见异常.妊娠24+5周复查超声,发现胎儿与葡萄胎共存,胎盘与葡萄状组织界限清晰,妊娠26周胎死官内,引产1男死婴.胎儿娩出后产妇血β-人绒毛膜促性腺激素下降明显,但引产后第3周再次上升,官腔无组织残留,化疗2疗程后降至正常.胎儿尸体解剖未见结构异常,胎盘绒毛发育成熟,葡萄胎绒毛水肿明显,中央池形成,间质血管消失,滋养细胞增生,考虑为完全性水泡状胎块.(2)遗传学检查:胎盘组织染色体核型分析为46,XY,胎儿软骨、葡萄胎组织细胞培养失败.检测双亲、胎儿及葡萄胎的5个STR位点,胎儿为双亲来源的正常二倍体;葡萄胎的5个STR位点中有4个只含有父本的单一遗传信息(D4S2460没有诊断价值),为父本来源;葡萄胎既有来自父本Y染色体的等位基因,也有来自父本X染色体的等位基因,故葡萄胎为双精子受精形成的父源性杂合子.胎儿与葡萄胎的父本来源的等位基因不完全相同,推测本例完全性葡萄胎与胎儿共存为单卵三精子受精引起.结论STR检查可从遗传层面确定胎儿与完全性葡萄胎共存的诊断,有助于发病机制的研究.     

Twin pregnancy with a complete hydatidiform mole and co-existent live fetus: two case reports and review of the literature

Introduction  The aim of this study was to report the clinical features, management, and outcome of two cases of complete hydatidiform mole with a coexisting viable fetus and to review the literature. Case reports  In this article, we report on the well-documented follow-up of two cases of twin pregnancies with complete hydatidiform mole and a normal fetus. Genetic amniocentesis showed normal fetal karyotype in both of two cases. In the first case, a live male infant was delivered by a cesarean section because of severe maternal bleeding at 29 weeks of gestation. In the second case, termination of pregnancy was performed due to early onset of severe preeclampsia and vaginal hemorrhage. Conclusion  The chances of a live birth have been estimated between 30 and 35% and the risk of persistent trophoblastic disease is similar to singleton molar pregnancies in complete mole with coexisting fetus pregnancy. Therefore, in these pregnancies, expectant management instead of termination of pregnancy can be suggested.     

Twin pregnancy with a complete hydatidiform mole and surviving co-existent fetus

INTRODUCTION: Twin pregnancy with complete hydatidiform mole and co-existent fetus (CHMF) resulting in a healthy take-home baby is rare, with only 30 cases documented in detail in the literature. CASE REPORT: A 29-year-old woman conceived following two cycles of ovulation induction with clomiphene citrate. Successive ultrasound examinations demonstrated a normally growing live fetus alongside a normal placenta and an additional intrauterine echogenic mass with features of hydatidiform mole. At 17 week gestation, serum beta-hCG level was 25.38 multiples of the median. Genetic amniocentesis at 18.5 week gestation showed normal fetal 46XX karyotype. A cesarean section performed at 28 week gestation resulted in the delivery of a live normal female infant and two adjoining placentas. One placenta was normal and the other placenta was composed of vesicles of various sizes. Microscopic examination of the abnormal placenta confirmed complete hydatidifrom mole. The baby did well and serial maternal serum beta-hCG levels showed a declining trend and were undetectable by 7 weeks after delivery. CONCLUSION: Continuation of a twin pregnancy with CHMF is an acceptable option. There is, however, an increased risk of developing pre-eclampsia and fetal loss due to miscarriage. The chance of a live term birth is <50% with nearly 33% of the mothers developing persistent gestational trophoblastic disease after delivery. Thus, close surveillance of an ongoing twin pregnancy with CHMF is mandatory to detect potential early signs of maternal and fetal complications.     

Complete hydatidiform mole with coexistent live fetus in dichorionic twin gestation

Case report A 28-year-old patient gravida 3, para 2 was admitted at 16 weeks gestation with the diagnosis of complete hydatidiform mole with coexistent live fetus (CHMCF) in dichorionic twin gestation. The HCG level was 530,000 mIU/ml. The pregnancy was terminated by hysterotomy. Outcome Histopathologic analysis revealed a hydatidiform mole and a 17-week-old male fetus attached to the normal looking placenta by a double-vesseled cord. A final karyotype on cord blood samples confirmed normal 46 XY. Weekly performed serial HCG values showed declining trend and were undetectable by 10 weeks post delivery.     

Complete hydatidiform mole with co-existing healthy fetus: A case report

A twin pregnancy is described consisting of a complete hydatiform mole (CHM) with coexisting healthy fetus. Pregnancy occurred after IVF-ICSI. The couple wished to continue the pregnancy and a decision to accept was taken after having consulted the available literature, but at 18 weeks gestation pregnancy termination was inevitable for severe vaginal bleeding. A rising HCG, 25 days after the curettage made methotrexate treatment necessary and 24 months later there is no evidence of disease.     

Obstetrical and oncological outcomes of twin pregnancies with hydatidiform mole and coexisting fetus

ObjectiveTo evaluate the obstetrical and oncological progression of twin pregnancies with hydatidiform mole coexisting fetus (HMCF).Materials and methodsUsing a retrospective method based on patients from the Women's Hospital, Zhejiang University School of Medicine database between January 1990 and October 2020, 17 patients were histologically confirmed as having HMCF, and the patients' prenatal diagnosis, outcomes and development of gestational trophoblastic neoplasia (GTN) were reviewed.ResultsAmong these 17 cases, 11 (64.71%) cases were complete hydatidiform mole coexisting fetus (CHMCF), and 6 (35.29%) cases were partial hydatidiform mole coexisting fetus (PHMCF). The gestational age at diagnosis of CHMCF was significantly earlier than that of PHMCF [9 (8–24) vs. 18 (11–32) weeks, respectively, P < 0.05]. The live birth rate of PHMCF was slightly higher than that of CHMCF (33.33%; 18.18%), but this difference was not statistically significant. The overall rate of GTN incidence of HMCF was 47.06% (8/17), and the GTN rates of PHMCF and CHMCF were 33.33% (2/6) and 54.55% (6/11), respectively. There was no significant difference in the GTN rate between patients who chose to continue pregnancy and those who terminated pregnancy before 24 weeks of gestation. The GTN rate of patients with term delivery was not significantly higher than that of preterm delivery.ConclusionIn HMCF cases, the incidence rate of CHMCF was higher than that of PHMCF, and PHMCF is more difficult to diagnose in the early stage. Continuing pregnancy does not increase the risk of GTN compared to terminating pregnancy. In cases of HMCF, when the fetal karyotype is normal and maternal complications are controlled, it is safe to continue the pregnancy and extend it to term.     

Complete mole coexistent with a twin fetus

We report two cases of a complete hydatidiform mole coexistent with a live fetus diagnosed by DNA polymorphism analysis. A 27-year-old woman revealed symptoms of pre-eclampsia and ultrasound showed multicystic tumor and placenta coexistent with a live fetus at 16 weeks' gestation. The placenta with partly hydropic change and the fetus without anomaly were consequently evacuated. Another 30-year-old woman had a multicystic mass attached to a normal placenta with a 20-week live fetus on ultrasound examination. A hysterotomy was carried out because of persistent bleeding due to placenta previa. In both cases, DNA was extracted from the placental tissue and the tumor, as well as from maternal and paternal blood. Genetic analysis demonstrated that the placental tumor consisted of only paternal origin, which is consistent with the diagnosis of complete hydatidiform mole.     

Complete hydatidiform mole with coexisting dichorionic diamniotic twins following testicular sperm extraction and intracytoplasmic sperm injection

We present the first report of complete hydatidiform mole (HM) with coexisting dichorionic diamniotic twins. This pregnancy was achieved after testicular sperm extraction and intracytoplasmic sperm injection (ICSI) for azoospermia in the woman's husband. Standard in vitro fertilization may cause multisperm fertilization and increase triploid partial HM and complete HM, which arise from dispermic fertilization. In contrast, ICSI can avoid multisperm fertilization. In our case, paternal isodisomy in the molar tissue was confirmed by microsatellite analysis suggesting that it resulted from duplication of a haploid paternal genome following monospermic fertilization of an inactivated oocyte or from monospermic fertilization of an inactivated oocyte with a diploid sperm. Although the patient was eager to continue the pregnancy, the size of the HM component increased rapidly and termination of the pregnancy was required for pre-eclampsia-like symptoms at 15 weeks of gestation. After the operation, chemotherapy was initiated for persistent trophoblastic disease.     

Severe hyperthyroidism requiring therapeutic plasmapheresis in a patient with hydatidiform mole

A 38-year-old woman had a 4-week history of vaginal bleeding, heat intolerance and palpitations. Levels of β-human chorionic gonadotropin and thyroid hormones were abnormally high. After ultrasound diagnosis of a molar pregnancy, evacuation of the mole was planned with preoperative treatment involving the use of antithyroid drugs and plasmapheresis. Plasmapheresis was used to prepare for surgery in our patient who needed more rapid hormonal control. In conclusion, early diagnosis of molar pregnancy results in decreased incidence of significant complications related to hyperthyroidism.     

A case of twin pregnancy with complete hydatidiform mole and coexisting fetus following IVF-ET

Twin pregnancy consisting of complete hydatidiform mole (H-mole) and a coexisting fetus occurs with an estimated incidence of 1 per 22,000–100,000 pregnancies. The incidence of this unusual twin pregnancy with complete H-mole and a coexisting fetus after in vitro fertilization and embryo transfer (IVF–ET) is not thought to be greater than that of general population. We present an unusual twin pregnancy with complete H-mole and a coexisting fetus that occurred following IVF–ET, which was terminated at 21 weeks of gestation and developed into nonmetastatic gestational trophoblastic tumor.     

Twin pregnancy with a fetus and a complete hydatidiform mole

Twin pregnancy with a normal fetus and gestational trophoblastic neoplasia as a co-twin is a rare entity. We are reporting such a case and discuss its management.     

Identification of patients with persistent trophoblastic disease after complete hydatidiform mole by using a normal 24-hour urine hCG regression curve

Objective

The aim of this study was to establish a reference 24-hour urine human chorionic gonadotropin (hCG) regression curve in patients with complete hydatidiform mole (CHM) as diagnostic tool in the prediction of persistent trophoblastic disease (PTD).

Methods

From 2004 to 2011, 312 cases suitable for this study were registered at the Hydatidiform Mole Registry of the Royal Women's Hospital Melbourne, Australia. hCG levels of 61 patients diagnosed as having PTD according to FIGO 2000 criteria were compared with the 95th-percentile (p95) of the normal regression curve derived from hCG levels of 251 cases of uneventful CHM.

Results

In the test group of 61 patients PTD was diagnosed by FIGO 2000 criteria after a mean (± SD, min.–max.) of 7.6 (± 3.4, 3.0–16.7) weeks after evacuation of the mole while in the same group hCG values for the first time exceeded the upper limit of the 95th percentile significantly earlier after 4.5 (± 1.9, 2.0–9.9) weeks (P < 0.001).However, hCG levels of 14% of the cases of uneventful CHM at least once exceeded the upper limit of p95, showing that one single value above p95 is not accurate enough for the diagnosis of PTD.

Conclusions

The normal 24-hour urine hCG regression curve may be used as a tool in the follow-up of an individual case of CHM after evacuation. At least one hCG level exceeding the upper limit of p95 within 11 weeks after evacuation could be added to the current FIGO criteria, in order to diagnose PTD early, but the lack of it may also prevent unnecessary treatment.     

Complete hydatidiform mole coexisting with a live fetus after gamete intrafallopian transfer. A case report

BACKGROUND: Molar pregnancy with a coexisting live fetus is a rare occurrence. We report the only known case with a surviving coexistent fetus after gamete intrafallopian transfer (GIFT). CASE: After GIFT, a 28-year-old primary infertility patient was diagnosed as having a complete hydatidiform mole coexisting with a live fetus at 13 weeks of gestation. At 36 weeks of gestation, a cesarean section was performed due to elevated serum human chorionic gonadotropin (hCG) levels, and a male infant with a normal appearance and weighing 2,688 g was delivered. CONCLUSION: If the patient desires to try to carry the fetus to viability after counseling on the possible associated risks of malignancy, it is possible to achieve fetal viability if (1) there is decline in the serum hCG level after it peaks before the second trimester, (2) ultrasound reveals degeneration of the molar part, and (3) there are no complications of pregnancy.     

Serum levels of zinc and copper in hydatidiform mole

Objective The aim of this study was to identify any association between serum levels of trace elements zinc and copper and development of hydatidiform mole.Study design Blood samples of 35 patients with complete hydatidiform mole and 34 pregnant women controls were evaluated for serum levels of zinc and copper. Students t-test was used for comparison of mean values of serum zinc and copper and for demographic variables. p0.05 was considered statistically significant.Results Levels of zinc in serum were found to be significantly higher in hydatidiform mole patients than controls (86.3 vs. 68.7 g/l, p=0.027). Serum copper levels were significantly lower in hydatidiform mole patients than controls (123.8 vs. 147.8 g/l, p=0.039; Table 2).Conclusion This is the first study in the English scientific literature reporting higher serum levels of zinc and lower serum levels of copper associated with complete hydatidiform mole.