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Microsatellite DNA Genotyping and Flow Cytometry Ploidy Analyses of Formalin-fixed Paraffin-embedded Hydatidiform Molar Tissues
Published on: October 20, 2019
Clinico-Pathological Discordance in a Partial Hydatidiform Mole With Coexisting Live Fetus and Subsequent Aggressive
Giancarlo A Turri-Vasquez1, Gabriel A Eman-Greci1, Steffany Castro-El Fakhri1
1Department of Obstetrics and Gynecology, Hospital Universitario de Caracas, Caracas, VEN.
Twin pregnancies with a partial hydatidiform mole and a coexisting live fetus are exceptionally rare, and progression to chemoresistant gestational trophoblastic neoplasia (GTN) is even less common. We report the case of a 28-year-old nulligravid woman with prior ovulation induction who presented with a twin pregnancy consisting of a partial hydatidiform mole and a coexisting live normal fetus. Following spontaneous abortion and uterine evacuation, histopathological examination and immunohistochemistry demonstrated p57 positivity, supporting the diagnosis of partial hydatidiform mole, and a normal placental tissue with a fetus without malformations. Despite apparently favorable pathological findings, the patient developed giant theca-lutein cysts complicated by ovarian torsion, progression to GTN, resistance to methotrexate and actinomycin-D, and subsequent pulmonary metastasis. Multi-agent chemotherapy with EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine) achieved complete clinical and biochemical remission, with no evidence of recurrence after three years of follow-up. This case highlights that partial hydatidiform mole with a coexisting live fetus may rarely exhibit aggressive clinical behavior despite reassuring histopathological and immunohistochemical features. Careful clinical and human chorionic gonadotropin surveillance remains essential in complex molar pregnancies.
Twin pregnancies with a partial hydatidiform mole and a coexisting live fetus are exceptionally rare, and progression to chemoresistant gestational trophoblastic neoplasia (GTN) is even less common. We report the case of a 28-year-old nulligravid woman with prior ovulation induction who presented with a twin pregnancy consisting of a partial hydatidiform mole and a coexisting live normal fetus. Following spontaneous abortion and uterine evacuation, histopathological examination and immunohistochemistry demonstrated p57 positivity, supporting the diagnosis of partial hydatidiform mole, and a normal placental tissue with a fetus without malformations. Despite apparently favorable pathological findings, the patient developed giant theca-lutein cysts complicated by ovarian torsion, progression to GTN, resistance to methotrexate and actinomycin-D, and subsequent pulmonary metastasis. Multi-agent chemotherapy with EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine) achieved complete clinical and biochemical remission, with no evidence of recurrence after three years of follow-up. This case highlights that partial hydatidiform mole with a coexisting live fetus may rarely exhibit aggressive clinical behavior despite reassuring histopathological and immunohistochemical features. Careful clinical and human chorionic gonadotropin surveillance remains essential in complex molar pregnancies.
