Complete hydatidiform mole in women aged 40 to 49 years.
OBJECTIVE
To describe the clinical course of women aged 40 to 49 presenting with complete hydatidiform mole.


METHODS
All cases of complete mole diagnosed at the New England Trophoblastic Disease Center were reviewed. A total of 82 patients met the study criteria.


RESULTS
Study patients had a mean age of 44.2 years, gravidity of 4.6 and parity of 2.6. The mean hCG on presentation was 230,484 mIU/mL. Most patients presented with abnormal vaginal bleeding (77%). Of the 82 patients, 83% underwent dilation and curettage without prophylactic chemotherapy; 53% of those patients developed gestational trophoblastic neoplasia (GTN). Patients who developed GTN were significantly more likely both before and after evacuation to have higher hCG levels than those who did not. There were no GTN cases among patients receiving either prophylactic chemotherapy or upfront hysterectomy. Aggressive upfront therapy was associated with shortened time to hCG normalization and fewer lines of surgical or chemotherapeutic therapy.


CONCLUSIONS
All women in their 40s with complete mole are at high risk for GTN and might benefit from aggressive upfront therapy. Those patients with hCG levels >175,000 mIU/mL constitute an "ultra-high-risk" group for whom prophylactic chemotherapy or hysterectomy should be especially considered.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. kelias1@partners.org
Kevin M
KM
Elias
Melina
M
Shoni
Marilyn
M
Bernstein
Donald P
DP
Goldstein
Ross S
RS
Berkowitz
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006063:Chorionic Gonadotropin / Q000097:blood; D004107:Dilatation and Curettage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis* / Q000628:therapy*; D007044:Hysterectomy; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors; D014592:Uterine Hemorrhage; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000628:therapy*
D000970:Antineoplastic Agents; D006063:Chorionic Gonadotropin