Hydatidiform (Vesicular) Mole

Posted by e-Medical PPT Monday, April 2, 2012
Gestational Trophoblastic Disease
Complete vesicular mole
Partial vesicular mole
Invasive mole
Placental-site trophoblastic tumor
Choriocarcinoma

It is a benign neoplasm of the chorionic villi, characterized by:
Marked proliferation of the trophoplast,both the syncytium & cytotrophoplast are affected.
Oedema or hydropic degeneration of the connective tissue stroma of the villi which leads to their distension and formation of vesicles.
Avascularity of the villi: the blood vessels disappear from villi explaining early death of the embryo

Incidence:
1:2000 pregnancies in United States and Europe, but 10 times more in Asia.
Predisposing factors include :
  Race,deficiency of protein or carotene
The incidence is higher toward the beginning and more toward the end of the childbearing period.
It is 10 times more in women over 45 years old.

Pathology:
The uterus is distended by thin walled, translucent, grape-like vesicles of different sizes.
These are degenerated chorionic villi filled with fluid.
There is no vasculature in the chorionic villi leads to early death and absorption of the embryo.

Histologic section of a complete hydatidiform mole stained with hematoxylin and eosin.
Villi of different sizes are present.
 The large villous in the center exhibits marked edema with a fluid-filled central cavity known as cisterna.
Marked proliferation of the trophoblasts is observed.
 The syncytiotrophoblasts stain purple, while the cytotrophoblasts have a clear cytoplasm and bizarre nuclei.
No fetal blood vessels are in the mesenchyme of the villi.

Complete mole
The whole conceptus is transformed into a mass of vesicles.
No embryo is present.
It is the result of fertilization of enucleated ovum ( has no chromosomes) with a sperm which will duplicate giving rise to 46 chromosomes of paternal origin only.

Symptoms
Amenorrhoea: usually of short period (2-3 months).
Exaggerated symptoms of pregnancy especially vomiting.
Symptoms of preeclampsia may be present as headache, and oedema
Vaginal bleeding :
 The main complaint, due to separation of vesicles from uterine wall, there may be a blood stained watery discharge, the watery part is from ruptured vesicles.
Prune juice disharge may occur.
The blood is brown because it has retained for sometime in the uterine cavity.
The passage of vesicles is diagnostic.
The blood may be concealed causing enlargment & tenderness of the uterus...

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