Twin pregnancy with metastatic complete molar pregnancy and coexisting live fetus

Abstract

We present a case of a 34-year old G1P0 female with twin-gestation and positive prenatal screening. Initial ultrasounds demonstrated a normal live fetus with an indeterminate but persistent placental lesion. The patient presented at 23 weeks of gestational age with vaginal bleeding. On examination, a 2 cm vaginal lesion was identified. Further cross-sectional imaging demonstrated a normal appearing fetus with a mixed solid and cystic placental lesion as well as an additional lesion in the vagina. Metastatic workup revealed diffuse pulmonary metastases. Intravascular embolization was carried out to minimize the bleeding from the vaginal lesion, followed by the delivery of the fetus with an urgent Caesarean section and treatment with chemotherapy. Pathology and genetics testing confirmed diagnosis of a complete molar pregnancy with a coexisting live fetus. This case highlights the importance of any unexpected findings within the placenta or the uterus in a pregnant patient. The radiologist should maintain a high index of suspicion for gestational trophoblastic disease in such cases, communicate clearly with the clinical team and suggest appropriate additional imaging.

A high-risk gestational trophoblastic neoplasia derived from a complete hydatidiform mole with coexisting fetus identified by short tandem repeats analysis: A case report

“…Sebire et al reported that only four cases of GTN occurring in 77 cases of CHMCF pregnancies (5.2%) required multidrug combination chemotherapy [ 5 ], suggesting CHMCF does not present a high risk for GTN. However, previous case reports describe diagnoses of high-risk GTN after CHMCF or cases requiring multidrug combination chemotherapy for GTN (presumed to be high-risk GTN) [ [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ]. In six of 12 cases (50%), including the present case, single-agent chemotherapy was given as the initial chemotherapy for PTD.…”

Successful delivery of a twin pregnancy with complete hydatidiform mole and coexistent live fetus: a case report and review of literature

“…Since the management of these two conditions differs, distinguishing between them is important. This is a rare phenomenon [7,10,11], and as a result, not many of us are acquainted with this condition. In cases of a partial hydatidiform mole, pregnancy termination is advised, as the fetus is chromosomally abnormal.…”

“…With the recent advances in ultrasonography, CHMCF can even be incidentally detected starting late in the first trimester [103,108]. In this condition, the complete mole typically presents with a classical snowstorm appearance together with the presence of a normal placenta and a viable fetus [4,7,12,103,110]. Occasionally, a theca lutein cyst is detected on ultrasound due to a significantly elevated level of serum beta-hCG, suggesting a higher probability of CHMCF [45,103,109,111,112].…”

“…Therefore, as the prognosis and management of each are different, distinguishing between both possibilities is crucial [6]. The fetus that is accompanied by a partial hydatidiform mole is malformed and usually does not survive past midpregnancy [7][8][9], pregnancy termination is recommended once the diagnosis is made [10]. Complete hydatidiform mole with a coexistent fetus (CHMCF) can result in a viable fetus that may survive until delivery [2,3].…”

“…Complete hydatidiform mole with a coexistent fetus (CHMCF) can result in a viable fetus that may survive until delivery [2,3]. However, the management of patients with CHMCF is difficult due to its rarity and complexity [7,[10][11][12]. Although the fetus in CHMCF can be alive [2,3], the pregnancy is usually terminated due to consequences that can threaten the lives of both the mother and fetus [2,3,[13][14][15][16].…”