title: Clinical Presentation of Complete Hydatidiform Mole and Partial Hydatidiform Mole at a Regional Trophoblastic Disease Center in the United States Over the Past 2 Decades.
abstract: OBJECTIVE
  The aim of this study was to compare the clinical presentation and incidence of postmolar gestational trophoblastic neoplasia (GTN) among cases of complete mole (CM) and partial mole (PM) from 1994 to 2013.
  
  
  METHODS
  This study included all cases of patients with CM and PM from our trophoblastic disease center between 1994 and 2013. Their clinical and pathologic reports were reviewed. Gestational age at evacuation, features of clinical presentation, human chorionic gonadotropin levels, and the rate of progression to GTN were compared.
  
  
  RESULTS
  The median gestational age at evacuation was 9 weeks for CM and 12 weeks for PM (P < 0.001). Patients with PM had lower pre-evacuation serum human chorionic gonadotropin levels (P < 0.001), and they were also less likely to present with vaginal bleeding (P < 0.001), biochemical hyperthyroidism (P < 0.001), anemia (P < 0.001), uterine size greater than dates (P < 0.001), and hyperemesis (P = 0.002). Consequently, patients with PM were less likely to have been clinically diagnosed as moles compared with CM prior to uterine evacuation (P < 0.001). The development of GTN occurred in 17.7% (33/186) and 4.1% (7/169) of patients with CM and PM, respectively (P < 0.001).
  
  
  CONCLUSIONS
  This study indicates that, at our center over the past 20 years, both CM and PM were usually evacuated in the first trimester of pregnancy. Because CM more commonly presents with the signs and symptoms of molar disease than PM, CM is more commonly diagnosed prior to evacuation.
authors.affiliation: *Department of Obstetrics and †Trophoblastic Disease Center of São Paulo Hospital, Paulista School of Medicine, UNIFESP-São Paulo Federal University, São Paulo, São Paulo, Brazil; and ‡Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital; §New England Trophoblastic Disease Center, Donald P. Goldstein, MD, Trophoblastic Tumor Registry; ∥Dana Farber Cancer Institute/Harvard Cancer Center; and ¶Harvard Medical School, Boston, MA.
authors.forename: Sue Yazaki
authors.initials: SY
authors.lastname: Sun
authors.forename: Alexander
authors.initials: A
authors.lastname: Melamed
authors.forename: Naima T
authors.initials: NT
authors.lastname: Joseph
authors.forename: Allison Ann
authors.initials: AA
authors.lastname: Gockley
authors.forename: Donald Peter
authors.initials: DP
authors.lastname: Goldstein
authors.forename: Marilyn R
authors.initials: MR
authors.lastname: Bernstein
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
authors.forename: Ross Stuart
authors.initials: RS
authors.lastname: Berkowitz
mesh_terms: D000328:Adult; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000453:epidemiology*; D006801:Humans; D009511:New England / Q000453:epidemiology; D011247:Pregnancy; D014594:Uterine Neoplasms / Q000453:epidemiology*; D055815:Young Adult