CASE 1145 Published on 11.11.2001

Hydatidiform mole

Section

Genital (female) imaging

Case Type

Clinical Cases

Authors

A. Witzeling (1), L. Poncioni (1), A. Lamarre (1), K. Meagher-Villemure (2), P. Schnyder (1)

Patient

27 years, female

Categories
No Area of Interest ; Imaging Technique Ultrasound, Ultrasound, CT, MR
Clinical History
Patient admitted for pain and cramps of the lower abdomen and vaginal bleeding. Clinical examination revealed a tender lower abdomen and a large palpable pelvic mass extending up to the umbilicus level. Blood tests were normal except for a very high Human Chorionic Gonadotropin level.
Imaging Findings
Patient admitted for low abdominal pain and cramps and vaginal bleeding. Past history was not relevant. Clinical examination revealed low abdominal tenderness and a large palpable pelvic mass extending up to the umbilicus level. Blood tests were normal except for a very high Human Chorionic Gonadotropin level (beta-HCG) mesured at 162,900 mIU/mL. Abdominal sonography demonstrated a 11x 9.5x 6.5 cm hyperechogeneous intrauterine mass (Fig 1) with mixed solid portions and multicystic ones. The uterine wall was thin and well defined. The mass did not show invasive behaviour. The ovaries (Fig 2) were enlarged and contained multiple thin walled cysts. Contrast enhanced pelvic-CT (Fig 3) demonstrated a low-attenuation large intrauterine mass with heterogeneous borders and enlarged ovaries with multiple cysts. Curettage was performed. The material brought by the suction device (Fig 4) consisted in1,200 ml of a gelatinous substance containing multiple cysts looking as a brunch of grapes. The diagnostic of complete hydatidiform mole suggested by macroscopic examination was confirmed by histopathology.
Discussion
Gestational trophoblastic diseases (GTD) deal with a cluster of pathologic conditions arising from placental villous tissue. The clinical symptoms usually mimick an early pregnancy. They are characterized by an abnormal high beta-HCG level. They are subdivided in three entities relating to various levels of invasiveness: the hydatidiform mole, the invasive mole and the choriocarcinoma. Eighty-five per cent of GTD are hydatidiform moles, wich are distributed into two subtypes : complete and partial moles. Both relate to a noninvasive proliferation of swollen villi. The complete moles do not show embryonic tissues and cell nuclei are diploïc, while, in partial mole, cell nuclei are triploïc, and embryonic tissues are present. The incidence of hydatidiform mole is about 1 for 1,000 pregnancies in the USA and in Europe. The incidence is 7 -10 times higher in Asia. Women older than 40 years and younger than 20 are at higher risk. Personal or familial history represent additional risk factors. The clinical presentation of GTD is usually painless bleeding occuring during the first term of pregnancy and palpation of an uterus larger than expected. As a consequence of the trophoblastic hyperplasia, very high levels of beta-HCG are mesured in maternal blood and urine. Sonography portrays an echogenous intracavitary mass containing multiple small cysts. In 50% of cases, ovarian theca lutein cysts consecutive to high beta-HCG level can be observed. CT shows a large intrauterine mass, with low-attenuation center and intact surrounding myometrum, as well as adnexal cysts. The treatment of GTD consists in curettage and aspiration, but approximately 15% of complete moles and 1-5% of partial moles degenerate into invasive mole, and 5% of the complete moles in choriocarcinoma. In order to detect these two complications, the beta-HCG level has to be monitored during the first weeks following the curretage.
Differential Diagnosis List
Hydatidiform mole
Final Diagnosis
Hydatidiform mole
Case information
URL: https://www.eurorad.org/case/1145
DOI: 10.1594/EURORAD/CASE.1145
ISSN: 1563-4086