Complete hydatidiform mole in women older than age 50.
OBJECTIVE
To describe the presentation, clinical course and outcomes of women aged 50 or older who present with a new diagnosis of complete hydatidiform mole.


METHODS
All cases of complete hydatidiform mole diagnosed at the New England Trophoblastic Disease Center from June 1970 to April 2009 were reviewed. Twenty-two patients met the study criteria.


RESULTS
The mean age in the patient population was 52, gravidity 5.8, parity 3.7 and gestational age 10.4 weeks. The majority of patients (68.4%) reported regular menses immediately prior to the index pregnancy. The most common presenting symptoms were vaginal bleeding (81.0%), stigmata of pregnancy (47.6%) and nausea or vomiting (28.6%). We were unable to delineate characteristics that would distinguish those patients who developed gestational trophoblastic neoplasia (GTN) following dilation and curettage from those who did not. In contrast, 60% of the 15 patients initially treated with dilation and curettage developed GTN, while there were no cases of GTN among the 7 patients receiving primary hysterectomy.


CONCLUSIONS
The risk of developing GTN in this age group appears to correspond to the choice of initial surgical therapy rather than hCG level or demographic factors. Hysterectomy should be considered as the initial treatment of choice.
Elias
Kevin M
KM
New England Trophoblastic Disease Center, Boston, Massachusetts, USA. kelias1@partners.org
Goldstein
Donald P
DP
Berkowitz
Ross S
RS
D004107:Dilatation and Curettage; D005260:Female; D005865:Gestational Age; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis / Q000601:surgery*; D007044:Hysterectomy; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery*