Makindo Medical Notes.com

Hydatis comes from Greek meaning watery cyst and is a type of gestational trophoblastic disease (GTD) that occurs when an abnormal fertilization event leads to the growth of abnormal tissue within the uterus.

About

• Benign tumour of trophoblast cells which contains 46 chromosomes all of paternal origin
• Complete mole usually occurs when an empty egg is fertilized by a single sperm that then duplicates its own DNA
• Partial mole has 69 chromosomes - 2 sets of paternal and one maternal and no risk of choriocarcinoma
• Women under 20 or over 40 years of age have a higher risk

This tissue is characterized by the presence of swollen, fluid-filled villi that resemble grape-like clusters. Hydatidiform moles are classified into two types: complete and partial, based on the degree of abnormality and genetic composition.

Types of Hydatidiform Mole

• Complete Mole: This type occurs when an egg with no genetic material is fertilized by a sperm. The resulting tissue consists entirely of abnormal placental tissue without any fetal tissue. Complete moles have a higher risk of developing into invasive moles or choriocarcinoma, a type of cancer.
• Partial Mole: This occurs when an egg is fertilized by two sperm, resulting in an abnormal pregnancy with both abnormal placental tissue and some fetal tissue. The fetus is usually not viable, and partial moles are less likely than complete moles to develop into malignancy.

Clinical

• Can cause bleeding in early to mid-pregnancy often occurring in the first trimester
• Exaggerated normal pregnancy symptoms is a clue with severe Nausea and Vomiting due to elevated levels of human chorionic gonadotropin
• Passage of Grape-Like Cysts vaginally, which are swollen chorionic villi.
• Spread to lungs can cause haemoptysis and pleurisy
• Greatly elevated Beta HCG which can mimic TSH and cause hyperthyroid symptoms
• Preeclampsia (high blood pressure and protein in the urine) before 20 weeks of gestation

Investigations

• USS: The primary diagnostic tool, which typically shows a "snowstorm" pattern or the absence of a fetus in the case of a complete mole, or an abnormal placenta with a malformed fetus in the case of a partial mole. 1/30 develop choriocarcinoma
• hCG Levels:Blood tests usually show significantly elevated levels of hCG, much higher than expected for normal pregnancy.
• Histopathological Examination: Examination of the uterine contents after evacuation confirms the diagnosis and determines whether the mole is complete or partial.

Management

• Suction Curettage: surgical removal of the molar tissue from the uterus through suction curettage.
• Monitoring hCG Levels: hCG levels are monitored until they return to normal to ensure that all molar tissue has been removed and to detect any potential malignancy early.
• Chemotherapy: If hCG levels do not return to normal or if there is evidence of persistent gestational trophoblastic disease, chaemotherapy may be required.
• Hysterectomy: in women who do not wish to have more children, a hysterectomy may be considered to prevent recurrence.