Handbook of Gynecologic Oncology (PDF)

"bunch of grapes." Complete hydatiform moles are often evident clinically (large for dates) or sonographically because of these hydropic changes. An embryo is generally not seen. No fetal or nucleated red blood cells are seen, since embryonic resorption occurs prior to the development of a fetal circulation. Vaginal bleeding is the most common clinical presenting symptom. Anemia is often present. Theca lutein cysts are present in approximately one-quarter to one-third of patients. Preeclampsia and hyperemesis occur in approximately 25% of patients. Both theca lutein cysts and preeclampsia are associated with high hCG levels (usually 100,000 mlU/ml). Elevated thyroid hormone levels are frequently seen, but clinical hyperthyroidism is rare. Malignant sequelae following evacuation of a complete hydatiform mole occurs in approximately 20% of patients.

In most patients, the malignant sequelae is the diagnosis of invasive or persistent mole, although one-quarter to one-third of patients with malignant sequelae following a complete hydatiform mole will have gestational choriocarcinoma. Invasive hydatiform moles have the histopathologic features of complete hydatiform moles, but with invasion beyond the normal placental implantation site directly into the myometrium. They often penetrate the venous system. Venous penetration can lead to the development of vaginal and lung metastasis and symptoms of bleeding. Deep penetration can lead to uterine perforation. It is a dif.cult diagnosis to make on specimens derived from endometrial curettage, and as hysterectomies are done so infrequently in GTD, it is not a common diagnosis. In the spectrum of malignant potential, they are intermediate, between hydatiform moles and choriocarcinomas. Partial hydatiform moles are triploid conceptions. They have a more subtle histologic appearance. There is only focal, slight trophoblastic hyperplasia and focal, variable hydropic villi. There is scalloping of the villi with trophoblastic inclusions within chorionic villi.

The embryo survives longer than in complete hydatiform moles, usually approximately 8 weeks. Therefore, there is frequently either gross or microscopic evidence of a fetus. In addition, fetal red blood cells can be identi.ed within fetal vessels. Owing to both the presence of a fetus and the minimal hydropic changes in the villi, partial hydatiform moles can be easily underdiagnosed without histologic and/or cytogenetic studies. Clinically, patients have uterine sizes either small or appropriate for dates. Sonographic appearance is often that of missed or spontaneous abortion. Preevacuation hCG levels are usually low. Patients usually do not have theca lutein cysts. Malignant sequelae are uncommon, compared with complete hydatiform moles, and almost always consist of nonmetastatic postmolar GTD.