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Aims: Diagnostic separation of diandric triploid gestation, i.e. partial mole from digynic triploid gestation, is clinically relevant, as the former may progress to postmolar gestational trophoblastic neoplasia. The aim of the study was to investigate if the combination of abnormal histology combined with ploidy analysis‐based triploidy is sufficient to accurately diagnose partial mole. Methods and Results: A genotype–phenotype correlation study was undertaken to reappraise histological parameters among 20 diandric triploid gestations and 22 digynic triploid gestations of comparable patient age, gestational weeks, and clinical presentations. Two villous populations, irregular villous contours, pseudoinclusions, and syncytiotrophoblast knuckles, were common in both groups. Villous size ≥2.5 mm, cistern formation, trophoblastic hyperplasia, and syncytiotrophoblast lacunae were significantly more common in the partial hydatidiform mole. Cistern formation had the highest positive predictive value (PPV) (93%) and highest specificity (96%) for diandric triploid gestation, although the sensitivity was 70%. Cistern formation combined with villous size ≥2.5 mm or trophoblast hyperplasia or syncytiotrophoblast lacunae had 100% specificity and PPV, but a marginal sensitivity of 60%–65%. A moderate interobserver agreement (Kappa = 0.57, Gwet's AC1 = 0.59) was achieved among four observers who assigned diagnosis of diandric triploid gestation or digynic triploidy solely based on histology. Conclusions: None of histological parameters are unique to either diandric triploid gestation or digynic triploid gestation. Cistern formation is the most powerful discriminator, with 93% PPV and 70% sensitivity for diandric triploid gestation. While cistern formation combined with either trophoblastic hyperplasia or villous size ≥2.5 mm or syncytiotrophoblast lacunae has 100% PPV and specificity for diandric triploid gestation, the sensitivity is only 60% to 65%. Therefore, in the presence of triploidy, histological assessment is unable to precisely classify 35% to 40% of diandric triploid gestations or partial moles. [ABSTRACT FROM AUTHOR]

Abstract Background Molar pregnancies, encompassing complete and partial moles, represent a rare and enigmatic gestational disorder with potential ethnic variations in incidence. This study aimed to investigate relations of ethnicity with risks of complete and partial molar pregnancies within an Israeli population while accounting for age differences. Methods A retrospective study was conducted of data recorded during 2007–2021 in an academic medical center in Israel. The study population comprised 167 women diagnosed with complete or partial moles, for whom data were obtained through histological examination and P57 immunostaining. Maternal age and ethnicity were extracted from electronic medical records. Incidence rates were calculated per 10,000 live births, and a nested case-control study compared demographic characteristics and molar pregnancy incidences between Arab and Jewish women. Statistical analyses included age-adjusted comparisons, relative risk calculations and multivariate logistic regression. Results The overall risk of molar pregnancy was 22 per 10,000 live births (95% confidence interval [CI] 18–25). Among Arab women, the overall risk was 21 (95% CI 17–25), and for PM and CM: 14 (95% CI 11–17) and 7 (95% CI 5–10), respectively. Among Jewish women, the overall risk was 23 (95% CI 18–29), and for PM and CM: 12 (95% CI 8–17) and 11 (95% CI 7–16), respectively. Among Arab women compared to Jewish women, the proportion of all the partial moles was higher: (65.3% vs. 51.6%, p = 0.05). The incidence of partial mole was higher among Arab than Jewish women, aged 35–39 years (26 vs. 8 per 10,000, p = 0.041), and did not differ in other age groups. After adjusting for age, the relative risk of partial moles was lower among Jews than Arabs (0.7, 95% CI 0.4-1.0, p = 0.053). For Arab compared to Jewish women, the mean age at molar pregnancies was younger: 31.0 vs. 35.1 years. However, other factors did not differ significantly between Arab and Jewish women with molar pregnancies. In multivariate analysis, Jewish ethnicity was significantly associated with a higher risk of complete molar pregnancies (OR = 2.19, 95% CI 1.09–4.41, p = 0.028). Conclusion This study highlights ethnic differences in molar pregnancy risk within the Israeli population. Jewish ethnicity was associated with a higher risk of complete molar pregnancies, while Arab women had a significantly higher risk of partial moles. These findings underscore the need to consider ethnicity when studying gestational disorders. Further research should seek to elucidate the underlying factors contributing to these differences.

Abstract Background Complete and partial moles (PM) are the most common gestational trophoblastic diseases. Due to some overlapping morphological findings, ancillary studies may be necessary. Methods In this cross-sectional study, 47 cases of complete mole (CM) and 40 cases of PM were randomly selected based on histopathological criteria. Only those cases that were agreed upon by two expert gynecological pathologists and confirmed by the P57 IHC study were included. The expression level of the Twist-1 marker in villi stromal cells, as well as syncytiotrophoblasts, was evaluated quantitatively (percentage of positive cells), qualitatively (staining intensity) and as a total comprehensive score. Results Expression of Twist-1 is higher and more intense in villous stromal cells of CMs (p

A scar ectopic pregnancy exhibiting hydatidiform features is an extremely rare and clinically challenging entity. Delayed diagnosis and failure to treat such cases promptly can lead to devastating consequences. In this report, we present a case of cesarean scar ectopic partial molar pregnancy in a 37-year-old woman who presented with complaints of vaginal discharge with streaks of blood and lower abdominal pain. Diagnostic laparoscopy revealed an abnormal mass of brown soft tissue in the anterior wall of the uterus, measuring 13.0 × 9.0 × 2.0 cm, raising suspicion (in the context of elevated serum human chorionic gonadotropin levels) of a scar ectopic pregnancy. Open laparotomy was performed, and the scar ectopic mass was successfully removed. The histologic examination of the tissue revealed a partial hydatidiform mole. The patient experienced a full recovery postoperatively, with serum human chorionic gonadotropin levels gradually declining to normal values. This report is unique in its presentation of the clinicopathological features of cesarean scar ectopic molar pregnancy and the successful management of the condition.

Hydatiform mole occurs in 1/1000 singleton and 1/20000–100,000 twin pregnancies. Although the pregnancy often ends in a miscarriage or presents with many obstetric complications such as preeclampsia, vaginal bleeding, hyperthyroidism, prematurity, or fetal malformations, in some cases of twin pregnancy, one of the fetuses can develop normally. Coexistence of a viable fetus in a twin molar pregnancy is more commonly described for cases of complete hydatiform moles than partial hydatiform moles. A partial hydatiform mole coexisting with a normal fetus was suspected in a 40-year-old woman, G2P1, at twelve weeks of gestation of a twin dichorionic diamniotic pregnancy. Serial antenatal ultrasound scans and serial evaluations of human chorionic gonadotropin were performed, and a healthy baby was delivered at term without any obstetric or neonatal complications.A twin pregnancy with partial hydatidiform mole and a coexisting normal fetus is a rare obstetric condition that can result, under proper management, in the delivery of a healthy baby without any sequelae for the mother or child.

Background: Morphological examination still forms the main diagnostic tool in the differential diagnosis of molar pregnancies. However, there may be inter and intra observer variability in differentiating partial from complete moles, and hydropic abortions from partial moles. The study was aimed at confirming the diagnoses of hydatidiform moles over a ten-year period using p57KIP2 and Ki-67 immunohistochemical markers. Methods: All morphologically diagnosed cases of hydatidiform moles from 1st January 2006 to 31st December 2015 formed the study materials. The total number of deliveries within the study period was obtained from the obstetrics and gynaecology department. All the relevant request cards, tissue blocks and slides stained with Haematoxylin and Eosin (H&E) were retrieved from the departmental records and stained with p57KIP2 and Ki-67 immunohistochemical stains. Results: There were one hundred (100) histologically diagnosed cases of hydatidiform moles during the period of the study, of these 71 (71 %) met inclusion criteria. The ages-ranged from 15 to 50 years with a mean age of 29.6 + 1SD years. The highest prevalence was in the 2nd decade of life. The initial H&E diagnosis was 51 partial and 20 complete moles. Of the 71 cases of hydatidiform-moles analysed, 48 (67.6%) showed positivity for both p57 and Ki-67 immunostains and were classified as partial moles, whereas 23 (32.4%) were complete-moles for being negative for p57 immunohistochemical marker. No cases of hydropic abortions were seen. Conclusion: This study showed that hydatidiform-mole affected women more in their 2nd decade of life. Partial-mole is commoner than complete-mole, and with immunohistochemical markers such as p57 and Ki-67, it is easier to confirm the diagnosis of molar gestations and differentiate between partial-mole, hydropic-abortion, and complete-mole. [ABSTRACT FROM AUTHOR]

Background: Complete and partial moles (PM) are the most common gestational trophoblastic diseases. Due to some overlapping morphological findings, ancillary studies may be necessary. Methods: In this cross-sectional study, 47 cases of complete mole (CM) and 40 cases of PM were randomly selected based on histopathological criteria. Only those cases that were agreed upon by two expert gynecological pathologists and confirmed by the P57 IHC study were included. The expression level of the Twist-1 marker in villi stromal cells, as well as syncytiotrophoblasts, was evaluated quantitatively (percentage of positive cells), qualitatively (staining intensity) and as a total comprehensive score. Results: Expression of Twist-1 is higher and more intense in villous stromal cells of CMs (p < 0.001). Moderate to strong staining intensity in more than 50% of villous stromal cells, can differentiate CM and PM with 89.5% sensitivity and 75% specificity. In syncytiotrophoblasts of CM, Twist-1 expression was significantly lower than PM (p < 0.001). Negative or weak staining intensity in less than 10% of syncytiotrophoblasts, can distinguish CM and PM with 82.9% sensitivity and 60% specificity. Conclusion: A higher expression of Twist-1 in villous stromal cells of hydatidiform moles is a sensitive and specific marker for the diagnosis of CMs. An elevated expression of this marker in villous stromal cells suggests another pathogenic mechanism for more aggressiveness of CMs in addition to the characteristics of trophoblast cells. The opposite result was obtained in the expression of Twist-1 in the syncytiotrophoblasts, compatible with defects in the process of formation of these supportive cells in CMs. [ABSTRACT FROM AUTHOR]

Fekata Defere Tolcha, Abubeker Kedir Usman, Habtamu Beyene Senbeta, Telila Mesfin Tadesse Department of Obstetrics and Gynecology, Madda Walabu University, Goba Referral Hospital, Goba, Oromia, EthiopiaCorrespondence: Fekata Defere Tolcha, Email drfekata.tolcha@gmail.comBackground: Twin pregnancy with partial hydatidiform mole and a co-existing normal fetus (PHMCF) is a very rare clinical condition. It presents with various complications like preterm labor, pre-eclampsia, hyperthyroidism and fetal anomalies.Case Presentation: We report the case of a 40-year-old G13P10A2 mother who was referred to our hospital at 28 weeks as a case of twin pregnancy and pre-eclampsia. She had headache, epigastric pain, bilateral leg swelling, and decreased fetal movement for two days. Her physical examination was remarkable for raised blood pressure and uterus larger than gestational age. Ultrasound findings showed honeycomb-like echo suggestive of a molar pregnancy with a co-existing normal fetus. After she was admitted and managed for severe pre-eclampsia, a cesarean section was done to affect the delivery of a male neonate weighing 1400 grams. Histopathology confirmed the diagnosis of a partial mole with no malignant features. In follow-up, the serum β-HCG level normalized by the 7th week.Conclusion: PHMCF is a rare obstetric condition. Despite these pregnancies having a greater risk of complications, strict follow-up at a tertiary care hospital and timely management of complications can result in good outcomes for both the mother and the fetus.Keywords: partial mole, twin pregnancy, case report, pre-eclampsia

A euploid fetus in a partial molar pregnancy can develop umbilical cord abnormalities as pregnancy goes on. So, careful examination of the umbilical cord can determine fetuses at risk for ominous adverse effects. [ABSTRACT FROM AUTHOR]

Abstract A euploid fetus in a partial molar pregnancy can develop umbilical cord abnormalities as pregnancy goes on. So, careful examination of the umbilical cord can determine fetuses at risk for ominous adverse effects.

Objective: To evaluate the ultrasound diagnostic rates of complete hydatidiform moles (CHM) and partial hydatidiform moles (PHM) in women presenting with a missed miscarriage, the clinical complications at diagnosis and the risk of gestational trophoblastic neoplasia (GTN) after surgical evacuation and to compare our findings with those of the published literature by completing a systematic review and meta-analysis STUDY DESIGN: Retrospective review of the data of 295 women diagnosed with a histologically confirmed hydatidiform moles (HM) over a 15-year period, including 128 CHM and 167 PHM. All women were referred to a regional specialist centre for follow-up and further management. An electronic search of PubMed, Google Scholar and MEDLINE was performed for studies published between September 1973 and September 2017 reporting on the early ultrasound diagnosis of hydatidiform mole. Only cohort studies which provided ultrasound data confirmed by histopathology were included.Results: In the cohort study, ultrasound imaging diagnosed a significantly (p < 0.001) higher number of CHM (95/128 (74.2%) than PHM (68/167 (40.7%). Ovarian theca lutea cysts were observed in three CHM and one PHM. There were no cases of pre-eclampsia or thyrotoxicosis at the time of diagnosis. Maternal serum β-human chorionic gonadotrophin levels were abnormally low (< 0.5 MoM) in 5/51 (10%) CHM and 23/43 (53%) PHM and abnormally high (> 2.0 MoM) in 20/51 (39%) CHM and 2/43 (5%) PHM. Seventeen (12.3%) CHM and two (1.4%) PHM developed a GTN requiring treatment. In the literature the proportion of histologically diagnosed HM, suspected on ultrasound in early pregnancy, ranged between 34.2 and 90.2% for HM, 57.8 and 95% for CHM and 17.6 and 51.6% for PHM. The meta-analysis indicated substantial heterogeneity in the overall ultrasound diagnosis of HM and in the differential diagnosis between CHM and PHM.Conclusion(s): As around a third of CHM and two thirds of PHM are not diagnosed on ultrasound in cases of missed miscarriage, histopathological examination of all products of conception in case of early pregnancy failure is essential to detect molar changes. This is particularly important for the management of women with CHM who have a higher risk of developing a GTN. [ABSTRACT FROM AUTHOR]

Objective: To report the case of a partial molar pregnancy with live fetus and conduct a review of the literature regarding maternal and fetal complications associated to this condition. Materials and methods: Case report of a partial mole with a 33 weeks live fetus complicated by intrauterine growth restriction, oligohydramnios and severe preeclampsia. We report satisfactory maternal and neonatal outcomes and 1-year follow-up. A search was conducted in the Medline via Pubmed, LILACS, Ovid, Uptodate and Google Scholar databases using the following MESH terms: hiditadiform mole, partial mole, live fetus, coexisting live fetus. Case series and case reports of pregnant women with coexisting partial mole and live fetus at the time of diagnosis were selected and information regarding maternal and fetal prognosis was extracted. Results: Initially, 129 related titles were identified. Of these, 29 met the inclusion criteria, and 4 articles were excluded due to failed access to the full text. Overall, 31 reported cases were included; 9 ended in miscarriage, 8 in fetal demise or perinatal death, and 14 (45%) resulted in a live neonate. The most frequent maternal complication was preeclampsia in 6 (19.35%) cases. Conclusion: The coexistence of a partial mole with a live fetus poses a high risk of adverse perinatal outcomes and preeclampsia. The volume of information regarding this rare condition must be increased in order to better determine potential interventions in cases of euploid fetuses and to provide adequate counseling in clinical practice. Therefore, reporting these cases is important to build sufficient evidence about the natural course of this condition. [ABSTRACT FROM AUTHOR]

Partial hydatiform mole (MHP) represents a spectrum of trophoblastic-related disorders occurring during pregnancy. Also known as embryonal mole, it is characterized by a recognizable ovum abnormality with vesicular transformation of villi but with recognizable placental appearance and amniotic cavity containing the fetus. First-trimester spontaneous abortion most commonly suggests the diagnosis. Partial moles rarely persist beyond the first trimester and are then a cause of maternal and fetal complications and diagnostic confusion. MHP of genetic origin is triploid with extra chromosome of paternal origin. The coexistence of normal fetal karyotype and MHP is exceptional. We report a rare case of partial molar pregnancy with liveborn diploid fetus in a 36-year-old woman diagnosed with threat of premature labour associated with placenta previa at 27 weeks of amenorrhea (WA). [ABSTRACT FROM AUTHOR]

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Molar pregnancy has the highest incidence of all gestational trophoblastic diseases. This is a heterogeneous group of diseases, composed of precancerous lesions and gestational trophoblastic tumours. The hydatidiform mole is characterised by varying degrees of proliferation of syncytiotrophoblastic and cytotrophoblastic cells and stromal oedema. Based on established morphological and cytogenetic criteria, molar pregnancy is divided into partial and complete. The risk of persistent trophoblastic disease is higher in complete moles compared with partial moles. The aim of this study was to assess the importance of additional molecular methods as a conjunction to the standard histopathological analysis to accurately determine the type and origin of triploidy and to detect partial molar pregnancy. This study examined a total of 24 cases of triploidy. Apart from the detailed histomorphological analysis, a molecular analysis of the placental tissue and maternal DNA was also performed. Digynic triploidy was found in 15 cases, whereas diandric triploidy was found in nine of the cases. The results showed that due to the histomorphological overlap between partial molar pregnancy and hydropic abortions, concomitant histopathological analysis of the placental tissue and molecular analysis of the placental and maternal DNA can lead to correct diagnosis.

Placental mesenchymal dysplasia (PMD) is a rare benign placental abnormality. It is characterized by hydropic degeneration of stem villi, placentomegaly, and increased maternal serum alpha-fetoprotein(AFP). It can be associated with different congenital abnormalities, karyotype abnormalities, and feto-maternal morbidities. It is difficult to differentiate PMDfrom partial mole, complete mole with twin pregnancy in ultrasound, and in macroscopic examination. The current paper presentsa rare case of placental mesenchymal dysplasia in a young primigravida mother who delivered a normal fetus withnormal karyotype.

Background: The reported incidence of hydatidiform mole with coexisting pregnancy is one in 22 000–100 000 pregnancies, most of them being complete hydatidiform moles (CHM) with a fetus; however, the reported prevalence, for a partial mole with a coexisting fetus is 0.005–0.01% of pregnancies. Case report: This is a case report of a hydatidiform mole with a coexistent live fetus diagnosed at 18 weeks. After thorough counselling, the pregnancy was continued as per the patient’s desire. The pregnancy was closely monitored with serial Serum β hCG, and ultrasound for fetal growth. An emergency caesarean delivery was done at 30 weeks, due to bleeding per vaginam. A live baby was delivered with near normal Apgar score. The placenta with molar tissue was sent for histopathological examination. The histopathology revealed a complete mole with normal placenta. Her serum β hCG reached normal levels after delivery, and she is now on surveillance. Though the general trend is to terminate pregnancy in twins with coexistent mole in anticipation of complications, under close surveillance, optimal outcomes can be achieved. Conclusion: The option of continuing a twin pregnancy with a complete mole is acceptable. However a close surveillance is required to detect potential early signs of complications. Histopathological examination is essential in distinguishing between partial and complete mole and/or with ancillary studies.

Intramural partial molar ectopic pregnancy is among the rarest sites of molar changes, may mimic intramural myoma and seriously threaten maternal life. The diagnosis and treatment of this unusual site molar ectopic pregnancy present a clinical challenge. We report the case of a partial molar intramural ectopic pregnancy in a 44-year-old patient presented with multiple intramural myoma and confirmed on final histopathology examination.

Objectives: To determine the prevalence of different types of gestational trophoblastic disease, assess the factors involved in malignant conditions and to determine treatment outcomes. Methodology: A retrospective review was conducted to investigate all gestational trophoblastic disease cases from January 2002 to December 2011. Results: A total of 123 patients were diagnosed with gestational trophoblastic disease within ten years, including 98 cases of benign and 25 cases of malignant gestational trophoblastic disease. There were 53 (43.1%) patients with partial and 45 (36.6%) with complete hydatidiform mole. Malignant forms accounted for 25 (20.3%), persistent trophoblastic disease for 22 (17.9%) and choriocarcinoma for 3 (2.4%) cases. The risk of developing malignant gestational trophoblastic disease increased by 5% every year of life. Twenty-two women received methotrexate, including 19 stage I patients receiving single-agent methotrexate, with complete recovery achieved in 12 patients (63%). Seven stage I patients put on actinomycin D achieved complete recovery (37%). Three patients with choriocarcinoma received EMA-CO regimen as treatment. Conclusion: We estimated the prevalence of gestational trophoblastic disease at 2.8 in 1,000 pregnancies, which is higher compared to Europe/USA. The risk factors for malignant disease included age, high parity, and long interval since the last child birth. Standard treatment allows for favorable outcomes. [ABSTRACT FROM AUTHOR]

Background: Molar pregnancy (hydatidiform mole HM) is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and will fail to come to term. A molar pregnancy is a gestational trophoblastic disease which grows into a mass in the uterus that has swollen chorionic villi. These villi grow in clusters that resemble grapes. A molar pregnancy can develop when a fertilized egg does not contain an original maternal nucleus. The diagnosis of HM is based on its morphology. In classic cases, the abnormally large villi have a vesicular or a grape like appearance. Histologically, HM presents variable degrees of circumferential trophoblastic hyperplasia and epithelial atypia. Distinguish between complete mole (CM) and partial mole (PM) is difficult especially with early diagnosis and evacuation of molar pregnancies, however, the criteria are subjective and show considerable inter - observer variability. Unfortunately in our country the histological diagnosis is depend only on routine stain (H&E) which is not giving a clear results in some cases because of that, the study design to find the similarities and differences between the two types of molar pregnancy by using some of special stains which surely distinguish between complete and partial moles samples using immunohistochemical marker P57KIP2. Objective: To detecting if the special stain can be helpful to distinguish between the two types of molar pregnancy also to find the accuracy of the routine diagnosis of hydatidiform mole comparing with P57 immunohistochemistry stain. Patients and Methods: The study conducted at the maternal teaching hospital in Erbil city. Thirty cases of Molar Pregnancy diagnosed, 15 of them were complete and the others were partial mole. All the samples studied histologically using H&E and some of special stains including: PAS stain, Congo red, and Trichrom, to describe the morphological differences between the two types of mole. Also immunohistological P57 stain was used in this study to confirm the type of mole. Results: The study result shows the morphological variation between complete and partial hydatidiform through using the routine H&E stain and special stains. The complete hydatidiform mole sections showed vesicular swelling of chorionic villi and circumferential trophoblastic hyperplasia, the trophoblastic proliferation grade varying in complete samples, most samples showed grade II (46.6%) of trophoblastic proliferation, while few of samples showed grade III (13.3%). The cases of partial hydatidiform mole showed scattered hydropic villi with irregular scalloped villous outlines and mild trophoblastic hyperplasia, trophoblastic distribution elucidate that the majority (60%) of samples show zonal distribution and high percentage (73.3%) of focal trophoblastic proliferation. The vessels in the villous stroma of most of partial molar samples (80%) was obviously seen also the cistern appear clearly in 73.33% of the samples and all partial molar pregnancy samples showed presence of fetal part in contrast to complete mole. The PAS stain show no different between the two types of molar pregnancy samples while the Congo red stained the partial molar samples intensely comparing with complete samples opposite to the trichrome stain which showed highly color intensity in complete than in partial samples. In this study the most important noticed results was high percentage (26.66) of positive result of P57 in complete diagnosed sample by routine way. Conclusion: The special stains can be helpful in diagnosis of hydatidiform mole and The study of p57 immunohistochemistry stain indicate present of misread in routine diagnoses of complete hydatidiform due to mimic morphological char [ABSTRACT FROM AUTHOR]

When placenta appears large on ultrasound, there are certain differential diagnoses to be kept in mind. We present a series of three cases in which large placenta was observed in first trimester scan. All three pregnancies resulted in Foetal Growth Restriction (FGR) associated with placental morphological abnormality.

We evaluated the accuracy of the ultrasound signs suggestive of complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM) in a cohort of women with histologically confirmed hydatidiform mole (HM) who presented with early pregnancy failure, including 103 CHM and 95 PHM for which ultrasound images were available. The accuracy of the differential diagnosis was significantly (p < 0.001) greater during secondary examination of ultrasound images compared with the original primary ultrasound examination. The interobserver agreement analysis indicated only a fair to moderate agreement between the two examinations (kappa value 0.41; 95% CI 0.29-0.53). Most HM present as early pregnancy failure and identification of early ultrasound signs can improve the differential diagnosis between CHM and PHM. [ABSTRACT FROM AUTHOR]

Partial/complete hydatidiform mole with coexisting fetus is a rare condition. Optimal management is a challenge that remains a dilemma since these pregnancies are associated with maternal as well as fetal complications including hemorrhage, preeclampsia, thromboembolic disease, intra uterine demise and increased risk of persistent trophoblastic disease. Here we report 2 cases of partial mole with live fetus after ICSI and a case of complete mole with coexisting fetus after ICSI in a turner mosaic that resulted in a live birth.

Introduction The primary aims of this study were to establish what proportion of ultrasonically suspected molar pregnancies were proven on histological examination and what proportion of histologically diagnosed molar pregnancies were identified by ultrasound pre-operatively. The secondary aim was to review the features of these scans to help identify criteria that may improve ultrasound diagnosis. Methods This was a retrospective observational study conducted in the Early Pregnancy Unit at King’s College Hospital London over an 11-year period. Cases of ultrasonically suspected molar pregnancy or other gestational trophoblastic disease were identified and compared with the final histopathological diagnosis. In addition, cases which were diagnosed on histopathology that were not suspected on ultrasound were also examined. In discrepant cases, the images were reviewed unblinded by two senior sonographers. Statistical analysis for likelihood ratio and post-test probabilities was performed. Results One hundred eighty-two women had gestational trophoblastic disease suspected on ultrasound examination (1:360, 0.3%); 106/182 (58.2%, 95% CI 51.0 to 65.2%) had histologically confirmed gestational trophoblastic disease. The likelihood ratio for gestational trophoblastic disease after a positive ultrasound was 607.27, with a post-test probability of 0.628.The sensitivity of ultrasound for gestational trophoblastic disease was 70.7% (95% CI 62.9% to 77.4%) with an estimated specificity of 99.88% (95% CI 99.85% to 99.91%); 102/143 (71.3%, 95% CI 63.4 to 78.1%) molar pregnancies were suspected on pre-op ultrasound; 60/68 (88.2%, 95% CI 78.2 to 94.2%) of complete moles were suspected on pre-op ultrasound, compared with 42/75 (56.0%, 95% CI 44.7 to 66.7%) of partial moles. On retrospective review of the pre-op ultrasound images, there were cases that could have been suspected prior to surgery. Conclusion Detecting molar pregnancy by ultrasound remains a diagnostic challenge, particularly for partial moles. These data suggest that there has been an increase in both the predictive value and the sensitivity of ultrasound over time, with a high LR and post-test probability; however, the diagnostic criteria remain ill-defined and could be improved. [ABSTRACT FROM AUTHOR]

Placental mesenchymal dysplasia (PMD) is a rare disorder of the placenta characterized by placentomegaly, cystic vesicles, and dilated chorionic blood vessels. Clinically and pathologically, it closely resembles partial molar pregnancy and complete hydatidiform mole with a coexistent healthy fetus, both of which are associated with malignant trophoblastic disease. PMD, however, has no risk of malignant trophoblastic disease and can result in the birth of a normal fetus, highlighting the need for clinician awareness of PMD in order to avoid unnecessary termination of a viable and potentially healthy fetus. [ABSTRACT FROM AUTHOR]

Partial molar pregnancy is a rare entity in which there is usually a triploid abnormal fetus associated with a large placenta with cystic changes. The incidence of a normal diploid fetus and a partial molar placenta is extremely rare. Here we report a case of partial molar pregnancy in which a normal appearing male fetus with diploid karyotype coexist. A focal placental abnormal region was detected at 11 week of gestation as enlargement associated with cystic changes. Fetus showed no obvious abnormality. The patient underwent amniocentesis and the result was compatible with a normal diploid male fetus. Regarding these findings the patient continued her pregnancy under close observation and advanced sonographic evaluations were made to rule out other differentials. There were no obstetric complications until the 26th gestational week when preterm rupture of the membranes occurred. The patient underwent induced vaginal delivery and the products were sent for pathologic evaluation which confirmed the partial molar changes.

Both partial mole and twin gestation are conditions associated with the risk of the early onset of pre-eclampsia. In cases of twin gestation, the death or selective termination of a severely growth-restricted fetus may lead to the reversal of maternal pre-eclampsia because of the involution or death of the pathological placenta, as has been reported by some authors. This case demonstrates that in a twin triploid gestation, in spite of the demise of one of the fetuses, the respective partial molar placenta can continue to grow and may contribute to the development or to the worsening of the pre-eclampsia. [ABSTRACT FROM AUTHOR]

Molar pregnancy has the highest incidence of all gestational trophoblastic diseases. This is a heterogeneous group of diseases, composed of precancerous lesions and gestational trophoblastic tumours. The hydatidiform mole is characterised by varying degrees of proliferation of syncytiotrophoblastic and cytotrophoblastic cells and stromal oedema. Based on established morphological and cytogenetic criteria, molar pregnancy is divided into partial and complete. The risk of persistent trophoblastic disease is higher in complete moles compared with partial moles. The aim of this study was to assess the importance of additional molecular methods as a conjunction to the standard histopathological analysis to accurately determine the type and origin of triploidy and to detect partial molar pregnancy. This study examined a total of 24 cases of triploidy. Apart from the detailed histomorphological analysis, a molecular analysis of the placental tissue and maternal DNA was also performed. Digynic triploidy was found in 15 cases, whereas diandric triploidy was found in nine of the cases. The results showed that due to the histomorphological overlap between partial molar pregnancy and hydropic abortions, concomitant histopathological analysis of the placental tissue and molecular analysis of the placental and maternal DNA can lead to correct diagnosis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Partial molar pregnancy with a coexistent live fetus is very rare. This type of mole mostly ends in the early termination of pregnancy due to an abnormally developed fetus., Case Presentation: Here, we report a case of a 24-year-old Indonesian woman with an ultrasonographic appearance of partial hydatidiform mole with initial placenta covering the internal uterine ostium in the late first trimester which then became marginal placenta previa in the third trimester. The woman decided to continue the pregnancy after considering the risks and benefits. The normal anatomy of the premature infant was vaginally delivered alive with a large and hydropic placenta., Clinical Discussion: Proper diagnosis, management, and monitoring remain challenging as this case is still rarely reported. Although embryos from partial mole forms generally do not survive since the first trimester, our case reported the singleton pregnancy with the coexistent normal fetus and the partial mole characteristic of the placenta. Diploid karyotype, few and focal extent of hydatidiform tissue of placenta, low rate of molar degeneration, and the absence of fetal anemia hypothesized as the factors that influenced survival of the fetus. There were two maternal complications such as hyperthyroidism and frequent vaginal bleeding without subsequent anemia in this patient., Conclusions: A rare case of partial hydatidiform mole coexistent with a live fetus with placenta previa was reported in this study. There were also maternal complications. Thus, prompt and regular monitoring of maternal and fetal condition holds an important role., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Choriocarcinoma is frequently preceded by a complete mole, ectopic pregnancy, nonmolar intrauterine abortion, and uncommonly by a partial mole. It is treated medically with chemotherapeutic drugs usually. However, we managed to save a life with appropriate and timely surgical intervention in a case of choriocarcinoma who presented with uterine rupture, haemoperitoneum, anaemia and hypovolemic shock. The patient underwent exploratory laparotomy and hysterectomy followed by systemic chemotherapy.

Objectives: Ploidy assessment is often required for the diagnosis of partial molar pregnancy. While fluorescence in situ hybridization has been shown to be effective, it is not available in many laboratories. We validated chromogenic in situ hybridization (CISH) for this purpose.Methods: CISH using probes to chromosomes 17 and 10 was performed on 20 POC cases with known cytogenetics to establish a reference percentage. This was then used to classify a randomized set of abnormal and normal cases.Results: An abnormal CISH cutoff of greater than 7% was established. All abnormal cases (six triploid and three tetraploid), 11 "normal" (46, XX or XY or undetectable abnormalities), and one trisomy 10 were all correctly classified by the assay.Conclusions: CISH is a useful ancillary technique for the diagnosis of molar pregnancy. Its greater accessibility and ability to score even rare placental tissue in a background of maternal tissue offer advantages over other methods. [ABSTRACT FROM AUTHOR]

Gestational Trophoblastic diseases consist of a broadspectrum of conditions ranging from an uncomplicated partial hydatidiform molar pregnancy to stage -IV choriocarcinoma with cerebral metastasis. Incidence of hydatidiform mole with a co-existing live fetus varies between 0.005 to 0.01% of all pregnancies. We report a case of partial molar pregnancy with alive term IUGR (intrauterine growth retardation) foetus. Diagnosis was made by sonographic findings of molar changes at her 28 weeks of gestation. Anomaly scan showed no fetal abnormality. At 40 weeks of pregnancy patient went to spontaneous labour and delivered a severely IUGR baby weighing 1.5 kg and it was morphologically normal. There was a single placenta; one third of it was replaced by molar tissue. As the singletone alive pregnancy with partial molar changes is extremely rare occurrence we reported the case here. [ABSTRACT FROM AUTHOR]

Objective: To determine the outcome of women with persistently raised but falling human chorionic gonadotrophin (hCG) levels 6 months after surgical evacuation of a molar pregnancy.Design: An 11-year retrospective review.Setting: The United Kingdom supra-regional trophoblastic disease treatment centres at Weston Park Hospital (Sheffield) and Charing Cross Hospital (London).Population: Women with raised but falling serum human chorionic gonadotrophin (hCG) levels 6 months after evacuation of a molar pregnancy.Methods: Retrospective case note review of eligible women identified by the electronic databases held at each supra-regional centre.Main Outcome Measures: The proportion of women that attain normal hCG levels spontaneously without chemotherapy. In addition, rates of gestational trophoblastic neoplasia (GTN), drug resistance, disease relapse and overall survival are reported.Results: Thirty-five women with molar pregnancy and raised but falling serum hCG levels continued surveillance 6 months after evacuation. Levels of hCG in 30 of the patients (86%) fell to normal levels spontaneously. One woman defaulted follow up prior to hCG normalisation (3%) and the remaining four women (11%) were treated with chemotherapy due to a plateau or rise in serum hCG levels indicating GTN. All treated women were successfully salvaged by either first (n = 1) or second line (n = 2) chemotherapy or found to have persistently raised low level hCG of uncertain clinical relevance (n = 1). No women developed relapsed disease and overall survival was 100%.Conclusions: Women with a molar pregnancy and a raised but falling hCG level beyond 6 months from uterine evacuation can be safely observed with regular hCG monitoring and can usually avoid potentially toxic chemotherapy.Tweetable Abstract: Women with treated molar pregnancy may avoid chemotherapy if 6-month hCG levels are raised but falling. [ABSTRACT FROM AUTHOR]

Objective To compare the age-specific incidence of complete (CM) and partial molar (PM) pregnancy in a large tertiary care center in the United States. Methods 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. Results 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 (p < 0.001). Compared to average age women, adolescents were 7.0 times as likely to develop CM (95% CI 3.6–8.9, p < 0.001), 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). Conclusions Adolescence and advanced maternal age were associated with increased risk of complete mole, but not partial mole. [ABSTRACT FROM AUTHOR]

Background: Gestational trophoblastic disease is a wide spectrum of abnormal pregnancy that includes: Complete molar pregnancy (CMP), partial molar pregnancies (PMP), invasive mole (IM), chorioncarcinoma (CHC), and placental site trophoblastic tumors (PSTT. Hydatidiform mole is an abnormal gestation characterized by the presence of hydropic changes affecting some or all of the placental villi. Hydatidiform mole arises as a result of the abnormal fertilization of an ovum. Tubal ectopic hydatidiform mole is a rare lesion and few cases have been reported. [ABSTRACT FROM AUTHOR]

When placenta appears large on ultrasound, there are certain differential diagnoses to be kept in mind. We present a series of three cases in which large placenta was observed in first trimester scan. All three pregnancies resulted in Foetal Growth Restriction (FGR) associated with placental morphological abnormality. [ABSTRACT FROM AUTHOR]

Intramural partial molar ectopic pregnancy is among the rarest sites of molar changes, may mimic intramural myoma and seriously threaten maternal life. The diagnosis and treatment of this unusual site molar ectopic pregnancy present a clinical challenge. We report the case of a partial molar intramural ectopic pregnancy in a 44-year-old patient presented with multiple intramural myoma and confirmed on final histopathology examination. [ABSTRACT FROM AUTHOR]