A Case of Rapid Transformation from Hydatidiform Mole to Invasive Mole: The Importance of β-hCG (Human Chorionic Gonadotropin) Serum Levels in Follow-Up Evaluation

Harsono, Ali Budi; Hidayat, Yudi Mulyana; Winarno, Gatot Nyarumenteng Adhipurnawan; Nisa, Aisyah Shofiatun; Alkaff, Firas Farisi

doi:10.12659/ajcr.931156

Cited by 6 publications

(9 citation statements)

References 19 publications

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“…The first line of management of invasive mole is chemotherapy, according to the WHO prognostication score. 5 The role of surgical management is limited in women with non-metastatic GTN, older patients with completed family, non-compliant patients, unable to follow up and not willing to chemotherapy, and in emergency situations e.g. acute abdomen, major hemorrhage, or sepsis.…”

Section: Discussionmentioning

confidence: 99%

Role of surgical management in invasive mole: a report of 2 cases and review of literature

Khoiwal

Yadav

Dash

et al. 2023

Int J Reprod Contracept Obstet Gynecol

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Invasive mole is a rare gestational trophoblastic neoplasia with proliferative trophoblast invading into myometrium or uterine vasculature. Primary management of invasive mole is chemotherapy, but hysterectomy can be performed in selective cases. In this report, we discuss two cases of invasive mole, which required surgical intervention in the form of a hysterectomy. Both patients had a favorable outcome and are in remission.

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Section: Discussionmentioning

confidence: 99%

Role of surgical management in invasive mole: a report of 2 cases and review of literature

Khoiwal

Yadav

Dash

et al. 2023

Int J Reprod Contracept Obstet Gynecol

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“…Our patient underwent suction and curettage twice, which might have caused damage to the uterine wall and contributed to the rupture. To our knowledge, all previously reported cases of invasive mole perforation with active bleeding were managed with surgery (5)(6)(7)(8)(9)(10). Further, some women with uterine perforation were managed with hysterectomy, and fertility preservation was not considered (5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, all previously reported cases of invasive mole perforation with active bleeding were managed with surgery (5)(6)(7)(8)(9)(10). Further, some women with uterine perforation were managed with hysterectomy, and fertility preservation was not considered (5)(6)(7). Some reports support the feasibility of fertility-preserving surgery in women who experience life-threatening hemorrhage caused by uterine rupture (8-10).…”

Section: Discussionmentioning

confidence: 99%

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Case report: Conservative treatment for fertility preservation in a woman with hemoperitoneum due to an invasive mole

Feng

Cai

et al. 2022

Front. Oncol.

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BackgroundInvasive moles are a subtype of gestational trophoblastic neoplasia (GTN) that usually develops after hydatidiform molar pregnancies. Uterine rupture in high-risk GTN is a rare and potentially catastrophic event. The treatment of invasive mole perforation with uterine rupture is particularly challenging in young women who desire fertility preservation.Case presentationWe present the case of a 22-year-old woman with a rapidly transformed invasive mole after two evacuations for a complete molar pregnancy. Within 21 days of the second molar evacuation, the serum β-hCG level surged from 5,718 mIU/ml to 444,617 mIU/ml. An ultrasonography examination showed the uterus was 9.2×8.9×7.8 cm in size with an uneven echo area of 6.9×5.2 cm near the fundus of the uterine cavity; the convex anterior wall had no normal muscle layer, and the outer margin was about 0.24 cm from the serosal layer. The patient was diagnosed with an invasive mole. Since she desired fertility preservation, we proposed a methotrexate (MTX) chemotherapy regimen. Before the planned chemotherapy, she experienced sudden abdominal pain accompanied by a blood pressure of 76/48 mmHg and a pulse rate of 116 bpm. An emergency abdominal ultrasound scan showed acute intra-abdominal bleeding (approximately 2,000 ml), and blood tests showed a hemoglobin concentration of 7.9 g/dL. Immediate uterine artery embolization was performed, and 35 mg MTX was administered bilaterally through the uterine arteries. The next day, the serum β-hCG decreased to 83,530 mIU/ml, and the vital signs remained stable. Seven days later, the patient received a combination of etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMACO), and the serum β-hCG level normalized after cycle five. At the 13-month follow-up after therapy completion, the woman was disease-free with a normal β-hCG level.ConclusionOur experience highlights the potential feasibility and efficacy of conservative treatment for fertility preservation in such scenarios.

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“…Hyperemesis gravidarum can occur in 0.3 %-3.6 % of pregnant women (1). HG, which is severe nausea and vomiting, can cause dehydration, acid-base, electrolyte disorders, ketosis (2,3), and cancer with long-term effects associated with increased Human Chorionic Gonadotropin (HCG) hormone (4)(5)(6). In addition, HG can also cause low birth weight (7), small pregnancies and preterm births (8)(9)(10), and nerve development delays in children born (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

The role of C-Reactive Protein in the level severity of hyperemesis gravidarum

Rosiyana¹

2022

Gac Méd Caracas

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A Case of Rapid Transformation from Hydatidiform Mole to Invasive Mole: The Importance of β-hCG (Human Chorionic Gonadotropin) Serum Levels in Follow-Up Evaluation

Cited by 6 publications

References 19 publications

Role of surgical management in invasive mole: a report of 2 cases and review of literature

Role of surgical management in invasive mole: a report of 2 cases and review of literature

Case report: Conservative treatment for fertility preservation in a woman with hemoperitoneum due to an invasive mole

The role of C-Reactive Protein in the level severity of hyperemesis gravidarum

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