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11 May 2021: Articles

A Rare Case of Early Transformation of Gestational Trophoblastic Neoplasia Following Molar Pregnancy

Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease

Febia Erfiandi A* , Kemala Isnainiasih Mantilidewi B , Yudi Mulyana Hidayat B , Ali Budi Harsono C , Dodi Suardi B , Siti Salima C , Andi Kurniadi C , Indah P. Islami D , Hasrayati Agustina D , Birgitta Maria Dewayani D , Aisyah Shofiatun Nisa E , Huda Toriq E

DOI: 10.12659/AJCR.930789

Am J Case Rep 2021; 22:e930789

Table 3. Diagnostic features of hydatidiform mole [13].

Diagnostic featureCHMVECHMPHM
Clinical presentationVaginal bleeding in second trimester (average 16 weeks). Excessive uterine size, hyperemesis, toxemia, preeclampsia or hyperthyroidismMissed 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 casesNormal or elevated (Normal or elevated (93% of cases)
UltrasoundSnowstorm pattern without fetus formationFocal cystic change with fetus formation
Chorionic villiDiffuse enlargement, round to oval shapesNormal size, polypoid or cauliflower shapesMild, with syncytiotrophoblast knuckles
Trophoblastic hyperplasiaMarked, often circumferential with intervillous trophoblast bridgingMild, often on villous tipsMild, with syncytiotrophoblast knuckles
Cytological atypiaMarkedMild to moderateLimited to mild
Villous stromaMarked edema with frequent cistern formation and trophoblastic inclusions. Absence of vasculature and nucleated RBCsCellular and myxoid with prominent karyorrhexis fetal capillaries may be presentOccasional cistern formation Round to oval trophoblastic pseudo-inclusion Presence of vasculature and nucleated RBCs (not always evident)
p57 ImmunostainAbsence of nuclear staining in cytotrophoblast and villous stromal cellsAbsence of nuclear staining in cytotrophoblast and villous stromal cellsPresence of nuclear staining in cytotrophoblast and villous stromal cells
DNA genotypingDiploid diandric (paternal-only) genomeDiploid diandric (paternal-only) genomeTriploid diandric-monogynic genome
CHM – complete hydatidiform mole; VECHM – very early complete hydatidiform mole; PHM – partial hydatidiform mole; RBC – red blood cell.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923