Les môles hydatiformes partielles au Maroc : étude épidémiologique et clinique

Abstract

RÉSUMÉ La présente étude rétrospective a examiné les cas de môle hydatiforme partielle (MHP) diagnostiqués au CHU de Casablanca de 2000 à 2010 et rapporte le profil épidémiologique, clinique, thérapeutique et évolutif de cette entité pathologique. Ont été inclus tous les cas de MHP évoqués échographiquement et cliniquement puis confirmés à l'examen anatomo-pathologique. Nous avons recensé 24 cas de MHP parmi 60 748 accouchements et 1704 avortements spontanés, ce qui donne une fréquence de 0,4 pour 1000 grossesses et 1,4 % des avortements. La moyenne d'âge était de 26 ans (extrêmes 16-55 ans). Les circonstances de découverte clinique et échographique étaient variées : 79,2 % des patientes consultaient pour des métrorragies ; un syndrome thyrotoxicosique clinique était retrouvé chez une patiente (4,2 %). L'examen physique montrait un utérus augmenté de taille dans 83,3 % des cas associé à une masse latéro-utérine dans 25 % des cas. Le diagnostic était étayé par un examen échographique associé à un dosage de β-HCG plasmatique. La confirmation était histologique dans tous les cas et le traitement était une aspiration endo-utérine. La dérive néoplasique a été observée dans un cas (4,2 %) qui a évolué vers la rémission sous chimiothérapie. Partial hydatidiform mole in Morocco: an epidemiological and clinical study ABSTRACT This retrospective study reviewed cases of partial hydatidiform mole (PHM) diagnosed at the University Hospital in Casablanca from 2000 to 2010 in order to examine the epidemiological, clinical, therapeutic and progressive pathological factors associated with PHM. All PHM cases confirmed clinically and sonographically at pathological examination were included. We identified 24 cases of PHM among 60 748 births and 1704 abortions, giving a frequency of 0.4 per 1000 pregnancies and 1.4% of abortions. The mean age was 26 years (range: 16-55 years). The circumstances of discovery and clinical ultrasound varied: 79.2% of patients sought consultation for bleeding; clinical thyrotoxicosis syndrome was found in 1 patient (4.2%). Physical examination showed increased uterine size in 83.3% of cases associated with a latero-uterine mass in 25%. The diagnosis was supported by an ultrasound examination combined with measurement of plasma βHCG. Histological confirmation was made in all cases and treatment was endo-uterine aspiration. Neoplastic drift was observed in 1 case (4.2%) which went into remission with chemotherapy.

Near death 18 weeks preeclampsia in molar pregnancy

“…In the CHM, associated with the presence or expression of the only paternal nuclear genome, hydropic degeneration is complete, and no trace of embryo, amniotic cavity and even vascularization is observed. 1 CHM is the most common form and represents 80% of gestational trophoblastic diseases. Its risk factors are numerous.…”

“…It is a benign entity but whose identification matters for two reasons: it can evolve towards clinically malignant entities, and the classifications of trophoblastic neoplasia that determine the therapeutic management take into account the type of initial gestation. 1 revealed by recurrent genital bleeding and exaggeration of the sympathetic signs of pregnancy (nausea and vomiting) with increase of the uterine volume compared to the gestational age, is usually conventional when it comes to a CHM.…”

Partial hydatidiform mole evolving into metastatic trophoblastic tumor: case report

“…5,11,13 This risk of degeneration into a trophoblastic tumor is linked to gestational age during uterine evacuation. 14 The embryonic molar pregnancy can be complicated by a pregnancy nephropathy related to a pathological trophoblastic colonization also giving cases of pre-eclampsia, in addition to an intra uterine growth retardation found in 93% of the cases. 6,8 A biological control by weekly dosing of plasma Bhcg associated with an emptiness ultrasound is essential, and monitoring -after negativation of the Bhcg level on three successive weekly dosages -is ensured by the dosing of the Bhcg rate monthly for 6 months under the control of a strict oral contraception is effective.…”

Complete Hydatiform Mole Revealed by a Severe Preeclampsia on Added in a 39-Year-Old Pregnant: Report of a Case Followed in Kisangani (DRC) and Review of the Literature

“…In the PHM, characterized by an imbalance between the two genomes with persistence of a maternal genome and at least two sets of paternal chromosomes, the egg retains a recognizable placental form and an amniotic cavity with an embryo, or traces of embryo. In the CHM, associated with the presence or expression of the only paternal nuclear genome, hydropic degeneration is complete and no trace of embryo, amniotic cavity and even vascularization is observed [1].…”

“…It is a benign entity but whose identification matters for two reasons: it can evolve towards clinically malignant entities, and the classifications of trophoblastic neoplasia that determine the therapeutic management take into account the type of initial gestation [1].…”