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Snap Shot
  • A 24-year-old Asian female presents with vaginal bleeding and abdominal pain in her 10th week of pregnancy. Ultrasound of the uterus reveals a snowstorm appearance and absence of the fetus
Introduction
  • Benign placental tumor with cystic swelling of chorionic villi and trophoblastic proliferation
  • Epidemiology
    • more common in Asian women
  • Can be complete or partial
    • complete mole 
      • most common type
      • 46, XX
        • empty egg with entry of 2 sperm
        • 46 paternal chromosomes
      • no fetus
    • partial mole
      • 69 XXY, XXX 
        • 46 paternal chromosomes + 23 maternal chromosomes
      • fetus present
Presentation
  • Symptoms
    • abnormal/painless vaginal bleeding
      • typically in 4th-5th month
    • vomiting
  • Physical exam
    • abnormally enlarged uterus for gestational age
Evaluation
  • Serology
    • ↑ β-hCG
      • higher in complete mole than incomplete mole
  • Ultrasound
    • intrauterine cystic mass without fetal tissue (complete mole) or with fetal parts (incomplete mole) 
    • complete moles classically have "snowstorm" appearance with no fetus
  • Gross pathology
    • "honeycombed uterus" or "cluster of grapes" gross appearance
Treatment
  • Surgical
    • dilation and curettage
      • monitor β-hCG following treatment
        • should fall to zero
  • Medical
    • methotrexate
Prognosis, Prevention, and Complications
  • Choriocarcinoma
    • may progress to choriocarcinoma
    • more common in complete moles
  • Uterine rupture
    • moles can lead to uterine rupture

 

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