Ultrasound diagnosis of coexisting molar pregnancy following referral for abnormal serum screen.
Complete hydatidiform mole and coexistent fetus is a rare occurrence. We report a case of a patient referred for abnormal serum screen and vaginal bleeding in the second trimester of pregnancy. Ultrasound revealed a cystic and solid mass along the posterior uterine wall with multiple hypoechoic (honeycomb) areas noted, consistent with molar degeneration of the placenta. Separate from this mass was a coexisting viable fetus with normal fetal anatomy and distinct anterior placenta. At delivery, a large cystic mass of placental tissue appeared to be implanted separately from a normal-appearing fetus and placenta. The mass weighed 184 g and contained multiple 1- to 1.5-cm cysts throughout. Microscopic sections revealed hydropic chorionic villi with central cistern formation and nonpolar trophoblastic hyperplasia with atypia, compatible with complete hydatidiform mole. This case illustrates that the diagnosis of coexisting molar pregnancy after referral for abnormal serum screen should be considered, especially if maternal serum beta-human chorionic gonadotropin is high and the patient has vaginal bleeding.
Monga
Manju
M
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas-Houston Medical School, Houston, Texas 77030, USA.
Schumacher
Vicki
V
Wicklund
Catherine A
CA
Brown
Richard
R
Le
Duc
D
Mastrobattista
Joan M
JM
D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging*; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012017:Referral and Consultation; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*; D000509:alpha-Fetoproteins / Q000032:analysis*
D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins