Complete mole

Complete mole
Updated: 12/04/2018
© Jun Wang, MD, PhD

General features
  • Diploid paternal only genome
  • Higher risk for invasive mole or choriocarcinoma
  • Poor prognostic factors: Large for date uterus, ovarian enlargement due to theca-lutein cysts
Key pathogenesis
  • Abnormal gametogenesis and fertilization
Invasive mole
  • Usually complete moles
  • Increased capacity of the trophoblast for invasion
  • May invade parametrial tissue, broad ligament and blood vessels, but serosa is usually intact
  • Present with uterine bleeding and elevated hCG after evacuation of a mole
  • Differential diagnosis
Choriocarcinoma: High hCG, but NO villi
Placenta increta or percreta: During delivery/parturition; NO hydropic villi, NO abnormal trophoblastic proliferation
  • Treatment: Chemotherapy
Clinical presentations
  • Vaginal bleeding or a missed abortion
  • Passage of grape-like vesicles
  • Disproportionately larger uterus for the stage of pregnancy
  • Increasing serum hCG levels after the 14th week (normally decreased levels)
  • Pre-eclampsia/eclampsia during early pregnancy stages
Key Laboratory findings
  • High serum hCG
Radiologic findings
Key morphological features
  • Numerous grape-like villi
  • Diffuse, circumferential trophoblastic proliferation
  • Avascular edematous villi and central cisterns
  • NO fetus
Markers
  • hCG
  • p53
  • NO p57 (expressed from maternal allele)
Genetic abnormalities
  • Diploid
  • Paternal only genome
  • Predominantly 46,XX, arising from duplication of the chromosomes of a haploid sperm after fertilization of an egg with inactive or absent maternal chromosomes
  • May be 46,XY as a result of fertilization of an empty ovum by 2 sperm (dispermy)
Treatment
  • Evacuation with curettage, if no invasion


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