Invasive mole: Indonesian perspective

To share our experiences concerning the characteristics of invasive mole (IM), including transformation and progression, its propensity to perforate, diagnostic and therapeutic procedures and prognosis.

A cross-sectional, descriptive, analytic study, conducted at Hasan Sadikin Hospital, Bandung, Indonesia.

There were 27 cases of IM, histologically confirmed. Seventy and three tenths percent were preceded by complete mole, 18.5% by partial mole and 11.2% by uncertain pathology. The average patient age, gravidity, transformation period and uterine size were 34.4 years, 4.4 pregnancies, 2.6 months and 14.3 weeks, respectively. Ultrasound findings in 20 cases were: 9 (45%) diagnosed as IM, 8 (40%) as choriocarcinoma, 2 (10%) as hydatidiform mole and 1 (5%) doubtful. Perforation occurred in 18 (66.7%) cases, 61.1% to the abdominal cavity, 5.5% to the uterine cavity and parametrium, 11.1% to the abdominal and uterine cavity and 16.7% to the abdomen and parametrium. There were 3 deaths, 2 due to perforation to the parametrium and 1 to the abdomen. Two cases developed metastasis, 1 to the vagina and the other to the lungs. Both survived. The surgical intervention rate was 96.3%, with all patients having hysterectomy except for 1 exploratory laparotomy.

IM should be suspected in multiparous patients with a history of mole and short transformation period. Ultrasound as a diagnostic tool is promising, but still needs further study. The incidence of perforation is high with possibility of death, yet the prognosis remains good provided that the acute period is managed appropriately. The method of follow-up is similar to mole.