[Role of hysteroscopy in diagnosis and management of trophoblastic disease]

To confirm complete removal of trophoblastic tissues, hysteroscopy was performed in 21 patients after evacuation of hydatidiform mole with an interval of a week. In 15 of these cases, hysteroscopy employed within a week after evacuation of the mole revealed a residue of mole or necrotic decidua. Although complete removal was confirmed in 14 cases on the second hysteroscopy, re-curettage was necessary in 6 patients because necrotic tissues were still found in the uterine cavity. Possible diagnosis of invasive mole was made in 2 cases within 2 weeks after evacuation of the mole by hysteroscopic findings. Hysteroscopy was also performed in 27 patients who were suspected of having a trophoblastic disease from the clinical signs and urinary hCG titer. Hysteroscopic findings which suggested trophoblastic diseases were summarized in the following four categories; 1) the existence of vesicles, 2) buldging or 3) recess of the uterine wall with bleeding or dilated blood vessels and 4) hematoma of the uterine wall. In 9 of the 21 cases with choriocarcinoma, invasive mole or persistent trophoblastic disease, one or two of the above mentioned findings were noted. Moreover, it was possible to differentiate syncytial endometritis from trophoblastic disease from the hysteroscopic findings. Therefore, hysteroscopy seems to be a useful aid not only in confirming complete evacuation of hydatidiform mole but also in the diagnosis and management of malignant sequela.