1
|
Braga A, Padrón L, Balen JL, Elias KM, Horowitz NS, Berkowitz RS. Video Hysteroscopy in the Diagnosis of Molar Pregnancy in two Challenging Situations: Complete Mole with Normal hCG and Partial Mole with Early Gestational Age. J Minim Invasive Gynecol 2021; 28:1448-1449. [PMID: 33556583 DOI: 10.1016/j.jmig.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/22/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To present the first hysteroscopic findings of 2 cases of complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM) within the context of the patients' clinical histories. DESIGN Presentation of 2 hysteroscopic videos with narration of the intrauterine findings of molar pregnancy (MP) from Rio de Janeiro Gestational Trophoblastic Disease Reference Center. SETTING MP is characterized by abnormal fertilization that generates 2 clinical syndromes: CHM and PHM [1]. INTERVENTIONS In the first case, the patient was aged 50 years, and hysteroscopy was indicated to assess abnormal uterine bleeding in the presence of normal serum human chorionic gonadotropin (hCG) and transvaginal ultrassonography showing an endometrial cavity with heterogeneous content. Hysteroscopy found translucent hydropic structures diagnosed as CHM. The negative hCG value was due to the hook effect (hCG after dilution: 2 240 000 IU/L). In the second case, an 18-year-old patient underwent hysteroscopy to assess the endometrial cavity with retained abortion at 7 weeks in which, during conservative management, the hCG level increased over 4 weeks from 25 000 IU/L to 58 000 IU/L. Hysteroscopy visualized the embryo with its umbilical cord and hydatidiform vesicles diagnosed as PHM. CONCLUSION MP can be an incidental finding during hysteroscopy for abnormal uterine bleeding or retained abortion [2-4]. Knowing its morphology during hysteroscopy is helpful for the correct management of this uncommon clinical situation. Hysteroscopy as an adjunct diagnostic tool (not as first-line treatment for MP) can be of significant benefit in challenging clinical scenarios. Further studies should assess the possible risk of spreading molar cells into the peritoneal cavity owing to hysteroscopic fluid.
Collapse
Affiliation(s)
- Antonio Braga
- Department of Obstetrics and Gynecology, Maternity School of Rio de Janeiro Federal University; Department of Maternal Child, Antonio Pedro University Hospital of Fluminense Federal University, Rio de Janeiro Trophoblastic Disease Center (Drs. Braga and Padrón), Rio de Janeiro, Brazil; Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University (Dr. Braga), Rio de Janeiro, Brazil; Postgraduate Program in Medical Sciences, Fluminense Federal University, Niterói (Dr. Braga), Rio de Janeiro, Brazil.
| | - Lilian Padrón
- Department of Obstetrics and Gynecology, Maternity School of Rio de Janeiro Federal University; Department of Maternal Child, Antonio Pedro University Hospital of Fluminense Federal University, Rio de Janeiro Trophoblastic Disease Center (Drs. Braga and Padrón), Rio de Janeiro, Brazil; Institute of Gynecology, Moncorvo Filho Hospital, Rio de Janeiro Federal University (Drs. Padrón and Balen), Rio de Janeiro, Brazil
| | - Jacir Luiz Balen
- Institute of Gynecology, Moncorvo Filho Hospital, Rio de Janeiro Federal University (Drs. Padrón and Balen), Rio de Janeiro, Brazil
| | - Kevin M Elias
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Drs. Elias, Horowitz, and Berkowitz)
| | - Neil S Horowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Drs. Elias, Horowitz, and Berkowitz)
| | - Ross S Berkowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Drs. Elias, Horowitz, and Berkowitz)
| |
Collapse
|
2
|
Sato W, Miura Y, Shirasawa H, Kumazawa Y, Kumagai J, Terada Y. A case of placental site trophoblastic tumor complicating nephrotic syndrome in which hysteroscopic biopsy did not yield a definitive diagnosis. Gynecol Minim Invasive Ther 2017; 6:69-72. [PMID: 30254879 PMCID: PMC6113977 DOI: 10.1016/j.gmit.2016.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 09/27/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022] Open
Abstract
Placental site trophoblastic tumor (PSTT) is the rarest subtype of gestational trophoblastic neoplasm. We present a case of PSTT complicating nephrotic syndrome. A 32-year-old woman experienced irregular menstrual bleeding and lower extremity edema 18 months after delivery. She was diagnosed with nephrotic syndrome and exaggerated placental site based on the hysteroscopic biopsy results. During follow-up, transvaginal color Doppler ultrasound showed an enlarged uterus filled with a hypervascular mass. Positron emission tomography–computed tomography showed diffuse accumulation in the entire uterus. The patient was diagnosed with PSTT only after total hysterectomy. Postoperatively, serum β-human chorionic gonadotropin decreased to within the normal range and her nephrotic syndrome resolved. She has remained without evidence of recurrence for 15 months. It is difficult to diagnose PSTT definitively. Most patients with PSTT are of reproductive age, therefore, to maintain fecundity, therapy development is expected.
Collapse
Affiliation(s)
- Wataru Sato
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yasuko Miura
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiromitsu Shirasawa
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yukiyo Kumazawa
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan
| | - Jin Kumagai
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|