Season 10 Case 2

History: +Urine Pregnancy test. LMP = 6wks ago. Vaginal Bleeding

Season 10 Case 2

History: +Urine Pregnancy test. LMP = 6wks ago. Vaginal Bleeding


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Answer:

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Answer: Molar Pregnancy (aka hydatidiform mole)

While a vast majority of pregnancies either spontaneously abort or proceed to delivery, many things can go wrong. One of those is when the trophoblasts (ie the cells that form the outer layer of the blastocyst and eventually develop into the placenta) go haywire leading to:

  • Hydiatidiform Mole

    • complete (100% abnormal, no normal fetal/placental parts)
    • partial (some normal fetal parts or placenta)
    • coexistent (twin gestation where A = normal and B->mole (very rare)
  • Invasive Mole

    • hydatidiform mole that invades the myometrium
  • Choriocarcinoma

    • malignant and metastatic version of invasive mole

Our case:

  • Transabominal and transvaginal imaging demonstrates a hyperechoic complex mass filling the uterus. Numerous small cystic areas. Given +pregnancy test, findings consistent with molar pregnancy
  • Main differential would be blood products or retained products of conception (RPOC). Blood products are generally more heterogeneous in appearance and would Not be vascular. RPOC are generally in the middle with some vascularity and hetereogeneity. History is usually helpful. Molar pregancy is less common than the other two options.

Radiology:

  • Enlarged uterus containing intrauterine mass

  • Mass generally hyperechoic with numerous cystic spaces, often with a somewhat uniform appearance.This is commonly referred to as "snowstorm" (numerous small cysts) or "cluster of grapes" (larger cysts). But can be a combination of both

  • ++vascularity - Look for high color flow on Doppler

  • Can have partial or fully formed fetus (ie partial mole)

  • Ultrasound is generally imaging of choice, but MRI can be used to fully evaluate for any fetal parts or if there is concern for invasion (MRI > US for sensitivity for invasion)

Treatment

  • Obstetrical suction and curettage for removal.
  • Serial bHCG levels can be used to monitor for residual disease (invasive/choriocarcinoma)