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Background: The coexistence of a hydatidiform mole and a fetus can occur in a multiple pregnancy, being less frequent in triplets and quadruplets because of their infrequency. With assisted reproduction, multiple pregnancies are becoming more frequent, and we can expect more frequent coexistence with a molar pregnancy. Case report: This G3, P1 30-year-old mother, after assisted conception, was diagnosed with a quadruplet pregnancy, one of which was a molar conceptus. Due to the potential for malignancy, the pregnancy was electively terminated. Conclusion: Despite the difficulty in conceiving, elective termination of a multiple pregnancy associated with a molar pregnancy may be the most judicious course of action to protect the mother's life.

Hydatidiform moles are classified at the genetic level as androgenetic complete mole and diandric-monogynic partial mole. Conflicting data exist whether heterozygous complete moles are more aggressive clinically than homozygous complete moles. We investigated clinical outcome in a large cohort of hydatidiform moles in Chinese patients with an emphasis on genotypical correlation with post-molar gestational trophoblastic disease. Consecutive products of conceptions undergoing DNA genotyping and p57 immunohistochemistry to rule out molar gestations were included from a 5-year period at Beijing Obstetrics and Gynecology Hospital. Patient demographics and clinical follow-up information were obtained. Post-molar gestational trophoblastic disease or gestational trophoblastic neoplasia was determined by the 2002 WHO/FIGO criteria. A total of 1245 products of conceptions were classified based on genotyping results into 219 complete moles, 250 partial moles, and 776 non-molar gestations. Among 219 complete moles, 186 were homozygous/monospermic and 33 were heterozygous/dispermic. Among 250 partial moles, 246 were triploid dispermic, 2 were triploid monospermic, and 2 were tetraploid heterozygous partial moles. Among 776 non-molar gestations, 644 were diploid without chromosomal aneuploidies detectable by STR genotyping and 132 had various genetic abnormalities including 122 cases of various trisomies, 2 triploid digynic-monoandric non-molar gestations, 7 cases of possible chromosomal monosomy or uniparental disomy. Successful follow-up was achieved in 165 complete moles: post-molar gestational trophoblastic disease developed in 11.6% (16/138 cases) of homozygous complete moles and 37.0% (10/27 cases) of heterozygous complete moles. The difference between the two groups was highly significant (p = 0.0009, chi-square). None of the 218 partial moles and 367 non-molar gestations developed post-molar gestational trophoblastic disease. In conclusion, heterozygous/dispermic complete moles are clinically more aggressive with a significantly higher risk for development of post-molar gestational trophoblastic disease compared with homozygous/monospermic complete moles. Therefore, precise genotyping classification of complete moles is important for clinical prognosis and patient management.

The incidence of twin pregnancies, consisting of a normal pregnancy and a mole is very low and affects about 1 in 100,000 pregnancies (Sebire et al. 2002). More than half of complete hydatidiform m...

Triplet pregnancies are rare and so are multiple pregnancies with one molar pregnancy. We report an exceptionally rare case of a triplet pregnancy with complete hydatidiform mole and coexistent nor...

Introduction: The aim was to study the expression of p57(KIP2) immunohistochemical marker in first trimester abortion specimens of molar and non-molar pregnancies. Materials and Methods: The study design was a cross-sectional study conducted in the Department of Pathology of a teritiary health care centre in South India. 100 cases of first trimester abortion specimens of molar and non-molar pregnancies were studied.The study duration was two years. The IHC used is p57(KIP2) which is a mouse derived monoclonal antibody and its expression in decidual and villous tissue of abortion specimens were observed. Result: Of 100 cases of first trimester abortion specimens 25 cases were complete mole, 17 were partial mole and rest 58 cases were normal abortions. p57 gene is paternally imprinted and maternally expressed, and the presence of its protein product serves as an useful adjuvant marker for the nuclear maternal genome. Regarding the expression of p57(KIP2) immunomarker in partial mole(PM) diagnosed previously by H&E 88% expressed positive results. These findings were highly statistically significant. The results of p57 IHC marker expression in cases of complete mole diagnosed previously by H&E, 96% expressed negative results which confirmed the complete mole diagnosis. Conclusion: The study of p57 immunohistochemistry in abortion specimens has proved to be an ancillary diagnostic tool in the diagnosis of complete mole. The sensitivity and specificity of p57 were very high in diagnosing complete mole from its close mimic partial mole in early first trimester abortions. The sensitivity and specificity were 96% and 88% respectively. Keywords: Hydatidiform mole (HM), Immunohistochemistry (IHC), Complete mole (CM), Partial mole (PM). Introduction Gestational trophoblastic disease are a group of benign and malignant entities, where the hydatidiform mole is the most common, and can be divided into complete hydatidiform mole and partial hyda

Introduction: Since the hallmark of gestational trophoblastic disease is trophoblastic proliferation, Ki67 is regarded as the best marker in studying hydatidiform mole.This study was conducted to evaluate the role of this proliferative marker in distinguishing among hydropic abortion, partial and complete hydatidiform mole. Materials and methods: This is a cross sectional study involving the application of Ki67 on a total of 90 histological samples of curetting materials from molar (partial and complete mole) and non molar hydropic abortion belong to Iraqi females, so three study groups were created. Immunohistochemical expression in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells were recorded separately by three independent observers and the results were correlated statically. Results: The mean number of stained nuclei of villous cytotrophoblasts and stromal cells was the highest in complete mole and the lowest in non molar hydropic abortion. There is a significant statistical relationship regarding Ki67 labeling index in villous cytotrophoblasts between partial moles and hydropic abortion, complete mole and partial moles, hydropic abortion and complete mole. Regarding Ki67 labelling index in villous stromal cells, a significant statistical relationship achieved when the correlation done between partial mole and hydropic abortions, hydropic abortion and complete mole, while a non significant statistical relationship was achieved if the correlation done between partial and complete mole. All villous syncytiotrophoblasts showed negative results. Conclusion: Ki-67 labeling index in villous cytotrophblastic cells are useful in separating between partial moles and hydropic abortion, partial mole and complete mole, hydropic abortion and complete mole. While Ki-67 labeling index in villous stromal cells is only useful in separating between partial moles and hydropic abortion, hydropic abortion and complete mole.

Introduction Current histomorphological criteria in distinguishing two subtypes of hydatidiform moles has considerable inter-observer variability and limitations. In this regard, ancillary studies can aid pathologist to obtain an accurate diagnosis. Herein, we evaluated the utility of Glycophorin-A (GLA) in differentiating complete and partial moles. Materials and methods In this case-control study, formalin-fixed paraffin-embedded blocks of 47 patients with pathologic diagnosis of complete and 42 partial hydatidiform moles were included and the diagnoses were confirmed by immunohistochemistry (IHC) for P57. Sections from all samples were stained for GLA using IHC method. Using 2 × 2 tables, the sensitivity, specifity, Positive and Negative Predictive Values (PPV and NPV) as well as accuracy of GLA were determined. Results Primary pathologic diagnosis was changed in 7.1% and types of hydatidiform mole were specified in 11.9% of the cases after review of the slides and IHC study for P57. NRBCs were found in 52.7% of the PM cases and none of CMs by pathologist in H&E sections. IHC study for GLA revealed positive result in one case of complete moles (2%) and 31 case of partial mole samples (73.8%). It was negative in 98% of the complete mole and 11 (26.2%) of partial mole cases. Discussion The results of this study showed a significant association between GLA immunoreactivity and type of molar pregnancy. Diagnostic sensitivity, specificity and accuracy of this marker for discrimination of molar pregnancy were 73.8%, 98% and 86.5%, respectively. Therefore, this marker can be utilized in differentiating partial and complete hydatidiform mole.

Gestational trophoblastic disease (GTD) is a major diagnostic category in gynecological pathology with hydatidiform moles being the most common entities. While the diagnosis of hydatidiform moles fundamentally requires routine histological assessment, it continues to suffer from intra- and inter-observer diagnostic variability, emphasizing the need for new diagnostic modalities. Emerged in recent years as powerful diagnostic methods for accurate classification of hydatidiform moles, p57 immunohistochemistry is highly useful in confirming the diagnosis of complete mole, and PCR-based DNA genotyping has become the gold standard to precisely classify both complete and partial hydatidiform moles. Algorithmic approaches combining traditional histomorphology and these powerful ancillary techniques provide the best diagnostic practice currently available.

We present our experience of using new 3-dimensional color/power Doppler sonography (HDliveFlow; GE Healthcare Japan, Tokyo, Japan) with the HD live silhouette mode for diagnosing complete molar pregnancy in the first trimester and differentiating it from missed abortion with hydropic degeneration. In the case of a complete mole, color Doppler sonography showed numerous vesicles without blood vessels, whereas HDliveFlow with the HD live silhouette mode clearly depicted these vesicles forming a mass with the clear demarcation of its edges and showed no blood flow inside the mass. In contrast to the hydropic abortion, which appeared as some vesicles with many blood vessels around them on color Doppler sonography, HDliveFlow with the HD live silhouette mode showed some vesicles embedded within the abundant blood vessels. The spatial relationship between the vesicles and surrounding highly vascularized uterus could be shown on HDliveFlow with the HD live silhouette mode. This technique might be beneficial as an additional diagnostic tool along with conventional color/power Doppler sonography, and it facilitates the early discrimination of these cases in the first trimester of pregnancy.

To compare the age-specific incidence of complete (CM) and partial molar (PM) pregnancy in a large tertiary care center in the United States.Incidence rates of CM and PM per 10,000 live births were calculated using databases from Brigham and Women's Hospital, between 2000 and 2013. Age-specific rates were calculated for women younger than 20 years old (adolescents), 20-39 years old (average age), and 40 years and older (advanced maternal age). Pearson χ(2) test was used to evaluate potential differences among groups. Rate ratios (RR) and 95% confidence intervals (CI) were used to compare risk of molar pregnancy among average age women with that of adolescents and women of advanced age. Holm-Bonferonni adjustment was used to correct for multiple comparisons.Between 2000 and 2013, there were 255 molar pregnancies (140 CM and 115 PM) and 105,942 live births, corresponding to a molar pregnancy rate of 24 per 10,000 live births (95% CI 21-27). Rates of CM and PM were 13 (95% CI 11-16) and 11 (95% CI 9-14) per 10,000 live births respectively. The incidence of CM differed significantly among maternal age groups (p0.001). Compared to average age women, adolescents were 7.0 times as likely to develop CM (95% CI 3.6-8.9, p0.001), and women with advanced maternal age were nearly twice as likely (1.9, 95% CI 1.8-4.7, p=0.002). The rate of PM did not vary significantly among age groups (p=0.26).Adolescence and advanced maternal age were associated with increased risk of complete mole, but not partial mole.

Molar pregnancy occurs when the fertilization of the egg by the sperm goes wrong and leads to the growth of abnormal cells or clusters of water filled sacs inside the womb. This condition is one of a group of conditions known as gestational trophoblastic tumours (GTTs). Molar pregnancies used to be called hydatidiform mole but now most people call them molar pregnancies. Molar pregnancies are rare but they are the most common type of gestational trophoblastic tumour. In the UK, about 1 in 590 pregnancies is a molar pregnancy. In Asian women, molar pregnancies are about twice as common as in Caucasian women. Most molar pregnancies are benign. They can spread beyond the womb in some women, but are still curable. Molar pregnancies can either be complete or partial. In case of complete mole, no parts of foetal tissue are formed. In case of partial mole there may be some foetal tissue in the womb, alongside the molar tissue. By measuring the levels of ?hCG in blood and urine in high dilution helps to diagnose a molar pregnancy; an ultrasound scan can also diagnose many women with molar pregnancy. The molar tissue needs to be surgically removed. Afterwards, in around 10 to 15 out of 100 women, some molar tissue remains in the deeper tissues of the womb or other parts of the body. This is called a persistent gestational tumour. Invasive mole, choriocarcinoma, and placental site trophoblastic tumor (PSTT) termed as “gestational trophoblastic neoplasia” (GTN), which can progress, invade, metastasize, and lead to death if left untreated.These women need to have chemotherapy completely get rid of the abnormal cells.Bangladesh Med J. 2015 Jan; 44 (1): 51-56

The coexistence of a complete mole and live term fetus is a rare entity seldom reported in the literature. Primary non-invasive diagnosis is usually achieved through ultrasound examination and definitive diagnosis can be achieved when molar tissue samples are available for histopathological examination. Patients with a complete mole have a 12-20% risk of developing persistent gestational trophoblastic disease, hence the importance of close follow-up. We report the early diagnosis of a complete mole coexisting with a normal fetus and also provide a review of the literature on the topic.

Background & objectives: There is considerable inter-observer variability in the diagnosis of molar pregnancies by histomorphological examination of products of conception (POC). The p57KIP2 gene is paternally imprinted and expressed from the maternal allele. On immunohistochemistry (IHC) with p57, complete mole (CM) shows absent staining whereas hydropic abortus (HA) and partial mole (PM) show positive staining. This study was undertaken to evaluate the role of p57 IHC along with histomorphology in differentiating between CM, PM and non-molar or HA. Methods: This was a cross-sectional study over a period of three and a half years on archival material. Detailed histomorphological review along with p57 IHC was carried out in 28 diagnosed cases (23 CM, 4 PM and 1 molar pregnancy not categorized) and 25 controls of four normal placentas and 21 POC (8 non-hydropic and 13 HA). Results: In 14.8 per cent (4/27) cases, there was discordance in accurate subtyping of molar pregnancy. One case of CM showed inconsistent IHC pattern. In 15.4 per cent (2/13) HA, molar pregnancy was final diagnosis. After final review, there were 25 CM, five PM, 22 non-molar controls including 10 HA and one not assigned (PM/HA). IHC with p57 was negative in 96 per cent CM and positive in 100 and 95 per cent PM and non-molar controls, respectively. Interpretation & conclusions: This study showed that negative p57KIP2 immunostaining reliably identified CM and could be used in association with the histological findings to distinguish CM from its mimics.

The density of imidazolium-based ionic liquid, 1-ethyl-3-methylimidazolium diethylphosphate with sulfolane were measured at atmospheric pressure. The experiments were performed at T= (293 – 343) K over the complete mole fractions. Physical and thermodynamic properties such as molar volumes, V0, and excess molar volumes, VE for this binary mixtures were derived from the experimental density data. The Jouyban-Acree model was exploited to correlate the physicochemical properties (PCPs) of binary mixtures at various mole fractions and temperatures.

Previous studies on the significance of hCG to predict gestational trophoblastic neoplasia (GTN) have been too small for robust conclusions to be reached. Our aim in this study was to analyse the significance of urine hCG in predicting GTN in a large population.Details of 3926 patients were available for analysis. Information regarding age, dates of diagnosis and registration, urine hCG levels, antecedent pregnancy and chemotherapy were prospectively collected and used for analyses. Patients were stratified into different groups according to urine hCG level (IU/L);50, 50-99, 100-249, 250-499, 500-999, 1000-9999 and ≥10,000. Multivariate analyses were used to identify the prognostic indicators of GTN.Urine hCG and antecedent pregnancy were the most powerful indicators for developing GTN (P0.01). None of the patients with partial mole and urine hCG50 IU/L (Normal level=40 IU/L) developed GTN. The risk of GTN was35% in all patients with urine hCG ≥500 IU/L. GTN developed in 70% of patients with complete mole and urine hCG ≥10,000 IU/L.Urine hCG is sensitive test for GTN. Urine hCG level is a powerful prognostic indicator for the GTN. Patients with partial mole could be safely discharged from the surveillance programme once their hCG have normalised. Patients with urine hCG ≥249 IU/L, whether partial or complete molar pregnancy, appear to benefit from intensive surveillance. Prophylactic chemotherapy could be considered when there are problems with surveillance.

Excess molar volumes, \({V^{\rm E}_{ijk}}\), and speeds of sound, uijk, of pyrrolidin-2-one (2-Py) (i)+benzene or methyl benzene (j)+propan-1-ol (k) ternary mixtures and speeds of sound, uij, of benzene or methyl benzene (i)+propan-1-ol (j) binary mixtures have been measured dilatometrically and interferrometrically over the complete mole fraction range at 308.15 K. Speed-of-sound data have been utilized to evaluate excess isentropic compressibilities for binary and ternary mixtures. \({V^{\rm E}_{ijk}}\) and \({\left({\kappa_S^{\rm E}}\right)_{ijk}}\) values have been fitted to a Redlich–Kister equation to predict ternary adjustable parameters and standard deviations. Topological investigations employed for predicting excess molar volumes and excess isentropic compressibilities, \({\left({\kappa _S^{\rm E}} \right)_{ij}}\), of 2-Py + benzene or methyl benzene or propan-1-ol binary mixtures have been extended to ternary mixtures (by employing the concept of a connectivity parameter of third degree, 3ξ, of a molecule) to obtain an expression that describes well the measured \({V^{\rm E}_{ijk}}\) and \({\left({\kappa_S^{\rm E}}\right)_{ijk}}\) values.

INTRODUCTION: The Gestational trophoblastic diseases (GTD) are a group of pregnancy related disorders arising from abnormal placental trophoblastic cells comprising of partial and complete mole. Trophoblastic cells have malignant potential. Gestational trophoblastic neoplasia (GTN) is its malignant sequelae encompassing invasive mole, choriocarcinoma and placental-site-trophoblastic tumor.

Excess molar volumes, $${V^{\rm E}_{ijk}}$$ , and speeds of sound, u ijk , of pyrrolidin-2-one (2-Py) (i)+benzene or methyl benzene (j)+propan-1-ol (k) ternary mixtures and speeds of sound, u ij , of benzene or methyl benzene (i)+propan-1-ol (j) binary mixtures have been measured dilatometrically and interferrometrically over the complete mole fraction range at 308.15 K. Speed-of-sound data have been utilized to evaluate excess isentropic compressibilities for binary and ternary mixtures. $${V^{\rm E}_{ijk}}$$ and $${\left({\kappa_S^{\rm E}}\right)_{ijk}}$$ values have been fitted to a Redlich–Kister equation to predict ternary adjustable parameters and standard deviations. Topological investigations employed for predicting excess molar volumes and excess isentropic compressibilities, $${\left({\kappa _S^{\rm E}} \right)_{ij}}$$ , of 2-Py + benzene or methyl benzene or propan-1-ol binary mixtures have been extended to ternary mixtures (by employing the concept of a connectivity parameter of third degree, 3 ξ, of a molecule) to obtain an expression that describes well the measured $${V^{\rm E}_{ijk}}$$ and $${\left({\kappa_S^{\rm E}}\right)_{ijk}}$$ values.

Background: Gestational trophoblastic disease (GTD) is a group of proliferative disorders of the placental trophoblast. While the etiopathogenesis is not fully understood, this spectrum of diseases has varied histological appearances, with clinical behaviors ranging from benign to malignant. The burden of this group of lesions seems to be more in the developing countries. A high index of clinical suspicion, early laboratory confirmation of the diagnosis, and prompt treatment ensure total cures, even of malignant disease. These diseases, just like gestation itself, are known to occur in both intrauterine and extrauterine (ectopic) sites. Aim and Objectives: This study sought to determine the morphological pattern as well as the age and site distribution of the various forms of ectopic GTD histologically diagnosed in the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, between January 1993 and December 2012. It is a hospital-based, retrospective review utilizing materials from the archives of the Department of Pathology, UBTH. The parameters studied include the specific histological diagnoses and the age and site distribution. Results: A total of 28 cases of ectopic GTDs were encountered. There were 17 cases (60.7%) and 8 cases (28.6%) of GTD found in the right and left fallopian tubes, respectively. Other sites of ectopic GTD were the left ovary (2 cases; 7.1%) and the right ovary (1 case; 3.5%). Partial mole was the most common (75.0%), followed by complete mole and invasive mole (10.7% each), and then choriocarcinoma (3.6%). The malignant: benign ratio was 1:27. Conclusion: Ectopic GTD, though still a relatively uncommon occurrence, should not be overlooked as a possibility in women with ectopic gestation, hence the need for histopathological and other ancillary evaluation of all ectopic conceptuses.

Complete hydatiforme mole with coexisting live fetus (CMCF) is a rare entity. Management for this rare twin pregnancy still remains undetermined. We report the delivery of a healthy baby coexisting with complete mole as twins. There was no other complication during or after the pregnancy.A 30-year-old multiparous woman was first time assessed in the antenatal outpatient department of our hospital at 17 weeks gestation for normal pregnancy control. Ultrasound examination showed a 17 week and 5 days viable fetus with normal anatomy and placenta. There was a second multicystic placenta located at the posterior wall of the uterus next to the normal placenta. Hydatiforme mole was suspected. The couple was informed about the possible complications but they were not willing to consider pregnancy termination or to have any invasive procedure for diagnosis. A cesarean section was performed at 33 weeks gestation due to premature rupture of membranes and initiation of labor with the fetus presenting as breech. After the delivery of a live healthy female 1,950 g baby, as well as the normal placenta, a second vesicular placenta was delivered. Histopathologic examination confirmed the diagnosis of complete mole.Today most of the twin pregnancies with complete mole are identified in the first or second trimester. In this case, the parents who choose continuation of pregnancy, are counseled about the increased risk of complications like preeclampsia, fetal loss, persistent gestational trophoblastic disease. Close surveillance of the woman with CMCF is mandatory during and after the pregnancy.

Gestational trophoblastic disease is a rare pregnancy-related disorder and its incidence is about 1 in 1000 livebirths in the West. It comprises of partial mole, complete mole, invasive and metastatic mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour. Novel immunohistochemical technologies have helped in the diagnosis of the disease and some of the genes may also serve as prognostic markers. Partial and complete moles can be treated by suction evacuation and most patients do not require further treatment. However, 10–20% of them may develop gestational trophoblastic neoplasia. The Gynecological Oncology Committee has adopted a staging system with incorporation of the modified World Health Organization scoring system. Low-risk disease is treated by single-agent chemotherapy while high-risk disease is treated by multi-agent chemotherapy. The overall cure rate is more than 90% and most patients can preserve fertility and anticipate normal pregnancy outcomes. Nevertheless, the disease can recur. Referral to a specialist centre is important to ensure proper monitoring and management.

Objective To investigate the value of PAPP-A (pregnancy assouated plasma protein-A) in the diagnosis and prognosis of gestational trophoblastic disease (GTD). Methods The serum β-HCG(β-human chorionic gonadotropin) and PAPP-A levels of 25 normal pregnant women, 28 patients with complete hydatidiform mole and 38 patients with invasive mole were measured by enzyme linked immunosorbent assay (ELISA) during the periods of diagnosis, treatment and follow-up. Results Compared with control group, patients with complete mole and invasive mole had higher levels of β-HCG ( P P > 0.05). The PAPP-A level of complete mole group was significantly higher than that of control group ( P P P Conclusion The PAPP-A level can give us some help not only in early diagnosis of hydatidiform mole and invasive mole, but also in the prognosis of malignant sequelae.

Hydatidiform mole, a disorder of fertilization, comprises complete and partial molar pregnancy. The pathologic and clinical features of complete and partial mole are well-described. Because of earlier diagnosis, however, the clinical presentation of complete molar pregnancy has significantly changed in recent years. The earlier diagnosis of complete mole is associated with more subtle pathologic findings than later molar pregnancy. The use of immunohistochemical techniques for the detection of maternally imprinted genes as ancillary testing in the diagnosis of complete and partial mole is therefore increasing. Although most molar pregnancies are sporadic, a familial syndrome of recurrent hydatidiform mole has been described. Further research will hopefully lead to identification of the gene defect responsible for this uncommon syndrome. Fortunately, patients with molar pregnancies can generally anticipate normal future reproduction. Close hCG follow-up after molar pregnancy is required to rule out development of postmolar gestational trophoblastic neoplasia. Recent studies suggest that a shorter period of postmolar follow-up may be reasonable for patients with both complete and partial molar pregnancy.

Introduction The epithelial to mesenchymal transition, a well-known and re-emerging model in pathology, has not been completely investigated in the field of gestational pathology. This study aims at improving the comprehension of this process in molar disease, even looking for new possible immunohistochemical markers. Materials and methods We have analysed the immunohistochemical expression of Twist1 and Snai2, two of the most important transcription factors involved in epithelial to mesenchymal transition, in formalin-fixed paraffin-embedded samples of 23 spontaneous abortive pregnancies, 22 molar pregnancies (10 partial and 12 complete) and 7 term placentas. Results Twist1 and Snai2 were highly expressed in stromal villi cells of molar disease. Particularly, Twist1 was highly expressed in complete moles compared to both abortive pregnancies (p < 0.001) and partial moles (p < 0.05). Also Snai2 was more expressed by complete moles, differentiating them from non-molar abortions (p < 0.05). Discussion On the basis of the known cadherins and claudins expression in these pathologies, our new findings reinforce the hypothesis of the involvement of epithelial to mesenchymal transition in early molar pregnancies and above all in complete moles. Furthermore, we highlighted that in molar disease not only the trophoblast, but even the villi stromal cells, are involved. Thanks to their specificity, furthermore, these Twist1 and Snai2 could be used as additional immunohistochemical tool in the diagnosis of complete molar disease, with Twist1 as the first choice. © 2015 Elsevier Ltd. All rights reserved.

Densities of {(1− x )CH 3 (CH 2 ) n −1 OH + x CH 3 CN} for n =1, 2, 3 or 4 have been determined as a function of composition at 288.15, 293.15, 298.15 and 303.15 K at atmospheric pressure using a vibrating-tube densimeter (Anton Paar DMA 4500, resolution 1×10 −5 g cm −3 ). Excess molar volumes were calculated. The V m E values were negative for acetonitrile–methanol mixtures and sigmoid for acetonitrile–alkanols (C 2 –C 4 ) mixtures over the complete mole fraction range. V m E values increase in a positive direction with increase in chain length of the alkanols and with the temperature. The E xtended R eal A ssociated S olution Model (ERAS-Model) calculations allowing for self-association for the alkanols and complex formation between acetonitrile and alkanols have been used to correlate experimental data. The model is able to reproduce the asymmetrical V m E behavior of the studied systems, although agreement between theoretical and experimental values is less satisfactory for some concentration ranges.

Background: A hydatidiform mole with a coexistent viable fetus is a rare entity. Case: This article reports a case of a 30-year-old, gravida 4, para 2, who presented at 14 weeks' period of gestation with bleeding per vaginum. Ultrasonography revealed a twin pregnancy consisting of a hydatidiform mole and a coexistent fetus. After a detailed discussion with the patient and her mate, the pregnancy was terminated. Results: A pathologic examination was consistent with a complete mole coexistent with a normal fetus and placenta. Serial monitoring of the patient's serum β–human chorionic gonadotropin was performed until this parameter was negative. Results: On follow-up, the patient has been free of persistent gestational trophoblastic disease (GTD). Conclusions: A hydatidiform mole coexistent with a viable fetus is rare and has poor prognosis. Continuation of pregnancy in CMCF is controversial because of the risk of maternal complications and risk of persistent GTD. (J GYNECOL SURG 28:150)

All cases of first histologically confirmed complete and partial moles registered between 1985 and 1999 were identified from the database of a Trophoblastic Disease Registration Centre. The maternal age distribution at diagnosis was calculated for the 7916 molar pregnancies and compared with the maternal age distribution of an unselected population of women from a routine obstetric database. Likelihood ratios were calculated for complete and partial molar pregnancies by maternal age. A positive relationship was found between the risk of molar pregnancy and both upper and lower extremes of maternal age (or = 45 years andor = 15 years, respectively). This association, although present for both complete and partial moles, is much greater for complete mole at all maternal ages, and the degree of risk is much greater with older (or = 45 years) rather than younger (or = 15 years) maternal age. This study provides, for the first time, data regarding specific risk of partial versus complete hydatidiform mole with maternal age.

We report a case of haemorrhage in early pregnancy following suction evacuation for a complete hydatidiform mole which later turned out to be case of placenta increta. Morbidly adherent placenta in early pregnancy a is rare event. There are few reported cases of obstetric hysterectomy in early pregnancy due to undiagnosed morbidly adherent placenta.

Aim: In this study, we aimed to determine the incidence of gestational trophoblastic disease by using data of patients who were treated for molar pregnancies. Material and methods: . The patients diagnosed as gestational trophoblastic disease between January 2009- January 2014 was evaluated retrospectively. Patients’ age, gravidity, parity and aborts were noted. Patients’ history, ultrasonographic findings, β HCG and laboratory results, hystopathology findings, treatment modalities and β HCG for following-up were recorded. Results: The incidence of molar pregnancy was found as 8 per 1000 deliveries. The mean age of patients was 28.72 ±7,5 and mean gestastional week was 10±2,4. β HCG values was found between 240 and 145100. Out of all patients, 20 (33.3%) had ultrasonographic signs of molar pregnancy. Pathology results revealed partial mole in 45 (75%), complete mole in 12 (20%) patients and choriocarcinoma in 3 (5%) patients. No mortality related to disease and complications was observed, Amaç: Bu çalışmada kliniğimizde molar gebeliktanısıyla tedavi edilen hastaların verilerikullanılarak gestasyonel trofoblastik hastalıklarıninsidansını belirlemeyi amaçladık.Gereç ve yöntem: Ocak 2009 ve Ocak 2014 yıllarıarasında kliniğimizde molar gebelik tanısı almışhastaların dosyaları retrospektif olarak incelendi.Hastaların yaş, gravida, parite ve abortus bilgilerikaydedildi. Olguların hikayesi, ultrasonografibulguları, β HCG ile birlikte laboratuar değerleri,histopatoloji sonuçları, tedavi yöntemleri ve takipteβ HCG değerleri kayıt edildi.Bulgular: Kliniğimizdeki molar gebelik insidansı1000 doğumda 5 olarak bulundu. Hastalarınortalama yaşı 28.72 ±7,5 olup ortalama gestasyonelyaş 10±2,4 haftaydı. β HCG değerleri 240 ile145100 arasında değişmekteydi. Hastaların20’sinde (%33.3) ultrason bulgusu molar gebelik ileuyumlu izlenmişti. Patoloji sonuçları 45 (%75)hastada parsiyel mol, 12 (%20) hastada kompletmol ve 3 (%5) hastada koryokarsinom gelmiştir.Olgularda hastalık ve komplikasyonlarına ait ölümolgusuna rastlanmamıştır.Sonuç: Kliniğimizde gestasyonel trofoblastikhastalık insidansı 1000 doğumda 5 olup daha kesinbir insidansa ulaşmak için ileri düzeyde araştırmalaryapılması gerekmektedir.Anahtar Kelimeler: Gestasyonel trofoblastikhastalık, insidans

Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases.

Forty molar and non-molar placentas with hydropic changes (14 complete moles, 14 partial moles, and 12 hydropic non-molar placentas) were examined immunohistochemically for expression of oncoproteins p53 and Bcl-2. The data were evaluated to determine if p53 and Bcl-2 expression could aid in differentiating molar from non-molar pregnancies on the one hand and complete mole from partial mole on the other. Thirteen out of fourteen complete moles showed p53 expression (93%), 8 of the 14 partial moles expressed p53 (57%), and none of the non-molar pregnancies expressed p53 in the extravillous intermediate trophoblasts. Regarding Bcl-2, the syncytiotrophoblasts of most molar and non-molar placentas showed strong and diffuse positivity. These results suggest that p53 expression can be used as a distinguishing parameter between complete moles and placentas with hydropic changes on the one hand and to a lesser extent between partial moles and placentas with hydropic changes on the other hand. Bcl-2 cannot be used in the same way as p53.

Objective. The aim of this study was to evaluate the clinical course and the management policy of complete mole coexistent with a twin live fetus confirmed with DNA polymorphism in a single hospital. Methods. From 1981 to 1995, six patients with androgenetic complete hydatidiform mole coexistent with a twin live fetus were diagnosed by DNA polymorphism analysis. The clinical course of these six patients was analyzed. Results. Two patients chose to terminate pregnancies and four patients desired to continue the pregnancy. However, the pregnancy had to be interrupted in two patients because of severe preeclampsia and sudden intrauterine fetal death. In two patients, fetuses were growing unremarkably and normal babies were delivered at term. The development of persistent trophoblastic tumor (PTT) in these rare pregnancies was higher (50.0%: 3/6) than that of single complete mole. In three patients, serum hCG titers during pregnancy were monitored. Although serum hCG levels progressively decreased during pregnancy in one patient without PTT, hCG levels initially decreased, but subsequently increased or showed a plateau with advancing gestational age in two patients with PTT. Conclusions. In patients with complete mole coexistent with a live fetus, the pregnancy may be allowed to continue when the fetal karyotype and development are normal and serum hCG titers are constantly falling with advancing gestational age.

The mutual diffusion coefficients of binary liquid mixtures of diethyl oxalate with ethanol and butan-1-ol in the complete mole fraction range were measured by the Taylor dispersion method. Experimental results at 293.15, 303.15, and 313.15 K are reported. The data are fitted by polynomial equations with an average absolute deviation of 1%. These experimental data are also satisfactorily correlated by a recently developed local composition UNIDIF model.

Ultrasonic velocities have been determined for binary mixtures of pyridine + n-alkanol (C1-C10) over the whole composition range at 25‡C. The excess isentropic compressibilities KSE and apparent molar isentropic compressibilities KΦ,s are estimated from these measurements. The KSE values are negative for all the systems over the complete mole fraction range except pyridine + decanol for which small positive values are obtained. The standard partial molar isentropic compressibilitiesK‡ of the alkanols are positive and increase linearly with the chain length of the alkanol molecules. It indicates that a methylene functional group makes a positive contribution to the expansion coefficient of a solute in these mixtures.

Ultrasonic speed, u, and excess volume, VE, measurements have been made for mixtures of pyrrolidin-2-one +n-alkanol (C6–C10) over the entire composition range at 303.15 K. VE values are negative for pyrrolidin-2-one + hexanol, S-shaped for heptanol and completely positive for rest of the mixtures and increase in the order hexanol < heptanol < octanol < nonanol < decanol. The VE results have been used to calculate the excess partial molar volumes of the components and have also been analysed using Prigogine–Flory–Patterson theory which divides VE into three contributions viz. the interactional, free volume and P* effects. It has been found that the dominant role is played by the interactional term which is the main parameter for deciding the sign and magnitude of excess volumes for pyrrolidin-2-one + alkanol (C6–C10) mixtures.The estimates of the isentropic compressibilities ks and of its excess counterpart, ksE have been computed from density values (calculated from excess volumes) in combination with ultrasonic speed data. The magnitude of ksE values are negative for all the systems over the complete mole fraction range and increase in the order hexanol < heptanol < octanol < nonanol < decanol. The apparent molar isentropic compressibilities ϕk,s have been derived and its limiting value text-decoration:overlineK° at an infinite dilution has been estimated.

Summary Hydropic villi in products of conception continue to pose a diagnostic problem for the anatomical pathologist. It is important to distinguish between complete hydatidiform mole (CM), partial hydatidiform mole (PM) and hydropic degeneration (HD), as hydatidiform moles (especially CM) have a tendency to develop persistent trophoblastic disease. Several studies have demonstrated interobserver variability in the diagnosis of the three conditions, but there have been no studies testing the accuracy of the consensus diagnosis of pathologists experienced in the field. In this study four anatomical pathologists with experience in diagnosing hydatidiform moles selected five cases of HD, seven cases of PM and ten cases of CM on the basis of consensus diagnosis using established criteria. Ploidy studies were done on these 22 cases using fluorescent in situ hybridisation. The 15 cases of HD and CM were diploid, confirming the histological diagnosis. However only five of the seven cases of PM were triploid, the other two being diploid. Review of these two diploid cases showed a mixture of small and large villi with moderate to marked trophoblastic proliferation. On the basis of the significant trophoblastic proliferation and the DNA information, the two cases were reclassified as early complete moles. This study demonstrates that even pathologists experienced in the field have difficulty separating PM from CM. The findings suggest that, in the absence of DNA information, a lesion with hydropic villi showing moderate to marked trophoblastic proliferation should be classified as a complete mole, even if there is a mixture of small and large villi. Ploidy studies are an important adjunct to histological diagnosis, especially when there is an overlap of features.

The association of a normal and a molar egg within a twin pregnancy is extremely rare. The key to diagnosis is the fetal karyotype, thus allowing elimination of its principal differential diagnosis: partial triploid mole. We report a case where the evolution of the pregnancy was complicated by severe toxemia. Interruption of pregnancy was then necessary, even though a conservative attitude had first been considered. Throughout this case, we discuss the means of diagnosis and the clinical handling of this rare entity.

Complete mole, also known as “classic” hydatidiform mole, is the prototype of molar gestation bearing the traditional description of “hydatid,” for example, grape-like structures at the time of evacuation, a term that was used throughout the last century. The historical tale of “365 babies” of the Dutch’s Countess Margaret of Henneberg (Chap. 1) clearly documented a case of a well-developed complete mole some 700 years ago. It is important to note that essentially all meaningful epidemiology data of hydatidiform mole in the literature have been based on studies of complete mole rather than partial moles. Epidemiological data on partial hydatidiform mole have been at best unreliable, largely because of significant diagnostic inaccuracy in practice, even at present time (see Chap. 1).

OBJECTIVE To evaluate the contribution of referent pathologists (RPs) to the quality of diagnosis of trophoblastic diseases and to study the level of diagnostic agreement between the initial pathologists and the RPs. METHODS This observational retrospective study was carried between 1 November 1999 and 11 January 2011 using the database of the French Trophoblastic Disease Reference Centre in Lyon. All files for hydatiform moles (HMs), trophoblastic tumours and non-molar pregnancies for which there was an initial suspicion of trophoblastic disease were included, whenever there was rereading of the slides by an RP. A total of 1851 HMs and 150 gestational trophoblastic tumours were analysed. RESULTS When the initial pathologist diagnosed a complete mole, the RP confirmed the diagnosis in 96% of cases. When the initial pathologist diagnosed a partial mole, the RP confirmed the diagnosis in only 64% of cases. For trophoblastic tumours, when the initial pathologist diagnosed a choriocarcinoma, the RP confirmed the diagnosis in 86% of cases. When the initial anatomopathology suggested an invasive mole, the diagnosis was confirmed in 96% of cases. Finally, when the initial diagnosis was a placental site trophoblastic tumour or an epithelioid trophoblastic tumour, the RP confirmed the diagnosis in 60 and 100% of cases, respectively. CONCLUSION A systematic policy of rereading of slides for all suspicious moles improves the quality of management of trophoblastic diseases at a national level.

AIMS--To assess the degree of difficulty in diagnosing partial mole by analysing intraobserver and interobserver agreement among a group of pathologists for these diagnoses. METHODS--Fifty mixed cases of partial mole, complete mole, and non-molar pregnancy were submitted to seven histopathologists, two of whom are expert gynaecological pathologists; the other five were district general hospital consultants, one of whom works in Australia. These participants gave each slide a firm diagnosis of either partial mole, complete mole, or non-molar pregnancy. Some 12 months later, the slides were recorded and again submitted for a second diagnostic round to assess intraobserver as well as interobserver agreement. Standard histological criteria for each diagnostic category were circulated with the slides. RESULTS--kappa statistics showed that complete mole could be reliably distinguished from non-molar pregnancy, but neither non-molar pregnancy nor complete mole could be easily differentiated from partial mole. In only 35 out of 50 cases was there agreement between five or more of the seven participants. Agreement between the expert gynaecological pathologists was no better than for others in the group. Interestingly, the intraobserver agreement for each pathologist was good to excellent. CONCLUSIONS--These results imply that the reported histological criteria are either not being applied consistently or that they are lacking in practical use. An atypical growth pattern of trophoblast, rather than the polar accentuation seen in normal first trimester pregnancies, seems to be the important diagnostic histological feature for partial mole. Ploidy studies might also help with problem cases.

Hydatidiform moles (HMs) are classified as partial or complete based on a combination of gross, histologic, and karyotypic features. Adherence to strict and reproducible diagnostic criteria is needed to ensure accurate diagnosis and minimize interpathologist variability. Using the kappa statistic as a measure of agreement, the morphologic, flow cytometric, and clinical features of 80 cases of HM or suspected HM were analyzed sequentially by three pathologists to evaluate intrapathologist and interpathologist variability. Poor interpathologist agreement was obtained when histology alone was used for diagnosis. The combination of gross morphology and histology resulted in poor to good agreement. Good interpathologist agreement was obtained, however, when objective data (DNA content determined by flow cytometry) were included in the analysis. Our data indicate that pathologist concordance is maximized when the diagnosis is based on a combination of morphology and DNA content.

Gestational trophoblastic diseases (GTD) presents most commonly as molar pregnancy or complete mole in the form of fluid filled vesicles, looking like a bunch of grapes and snow storm appearance on USG. The commonest symptom being irregular vaginal bleeding preceded by amenorrhoea. Uterine arteriovenous malformation with GTD is a very uncommon disorder and can be diagnosed by arteriography or color doppler. We present a case of GTD which was diagnosed as an invasive mole with a unique and unusual morphologic feature of arteriovenous malformation.

This review summarizes the primary management of molar pregnancies, surveillance after evacuation, and the evaluation and management of malignant gestational trophoblastic neoplasia (GTN). Most women with gestational trophoblastic disease can be successfully managed with preservation of their normal reproductive function. It is important to manage molar pregnancies properly to minimize acute complications and identify malignant sequelae promptly. Current International Federation of Gynecology and Obstetrics (FIGO) guidelines for making the diagnosis and staging of GTN allow uniformity for reporting results of treatment. It is important to individualize treatment for women with malignant GTN based upon risk factors, using less toxic therapy for patients with low-risk disease and aggressive multiagent therapy for those with high-risk disease. Patients with malignant GTN should be managed in consultation with an individual experienced in the complex, multimodality treatment of these patients.