Pemphigoid Gestationis after Spontaneous Expulsion of a Massive Complete Hydatidiform Mole

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/267268 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Naoki Matsumoto ◽

Marie Osada ◽

Kou Kaneko ◽

Ken Ohara ◽

Daito Noguchi ◽

...

Keyword(s):

Hydatidiform Mole ◽

Vital Signs ◽

Oral Prednisolone ◽

Skin Lesions ◽

Complement C3 ◽

Entire Body ◽

Complete Hydatidiform Mole ◽

Pemphigoid Gestationis ◽

Spontaneous Expulsion ◽

Hydatidiform Moles

Pemphigoid gestationis (PG) is a rare, perinatal, autoimmune, and blistering dermatosis. Only few cases of PG involving hydatidiform moles have been reported. Complete hydatidiform moles are usually evacuated by dilatation and curettage. We report a patient with a massive complete hydatidiform mole that underwent spontaneous expulsion; she subsequently developed PG. A 19-year-old unmarried nulligravid woman was referred to our hospital following excessive vaginal bleeding after an uncertain amenorrheal period. The patient presented with preshock vital signs, severe anemia, and a positive urine pregnancy test. Imaging examinations revealed a massive intrauterine mass (19 × 15 × 10 cm), suggesting a complete hydatidiform mole. She was hospitalized and treated with blood transfusion. Sixteen hours after hospitalization, the massive molar mass underwent spontaneous expulsion and bleeding ceased. Three days after the expulsion, she developed pruritic skin lesions including papules, erythemas, and bullae, which spread over her entire body. Skin biopsy revealed PG and subepidermal blister formation and linear complement C3 deposition along the basement membrane zone, and the serum anti-BP180 antibody level was found to be high on measurement. She was effectively treated with 50 mg/day of oral prednisolone. Her skin lesions disappeared, leaving pigmentation.

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Hydatidiform Moles: Ancillary Techniques to Refine Diagnosis

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0226-ra ◽

2018 ◽

Vol 142 (12) ◽

pp. 1485-1502 ◽

Cited By ~ 15

Author(s):

Brigitte M. Ronnett

Keyword(s):

Interobserver Variability ◽

Hydatidiform Mole ◽

Immunohistochemical Analysis ◽

Gestational Trophoblastic Disease ◽

Complete Hydatidiform Mole ◽

Algorithmic Approach ◽

Genetic Features ◽

Polymerase Chain ◽

Dna Genotyping ◽

Hydatidiform Moles

Context.— Distinction of hydatidiform moles from nonmolar specimens and subclassification of hydatidiform moles as complete hydatidiform mole versus partial hydatidiform mole are important for clinical practice and investigational studies. Risk of persistent gestational trophoblastic disease and clinical management differ for these entities. Diagnosis based on morphology is subject to interobserver variability and remains problematic, even for experienced gynecologic pathologists. Objectives.— To explain how ancillary techniques target the unique genetic features of hydatidiform moles to establish diagnostic truth, highlight the issue of diagnostic reproducibility and importance of diagnostic accuracy, and illustrate use of p57 immunohistochemistry and polymerase chain reaction–based DNA genotyping for diagnosis. Data Sources.— Sources are the author's 10-year experience using ancillary techniques for the evaluation of potentially molar specimens in a large gynecologic pathology practice and the literature. Conclusions.— The unique genetics of complete hydatidiform moles (purely androgenetic), partial hydatidiform moles (diandric triploid), and nonmolar specimens (biparental, with allelic balance) allow for certain techniques, including immunohistochemical analysis of p57 expression (a paternally imprinted, maternally expressed gene) and genotyping, to refine diagnoses of hydatidiform moles. Although p57 immunostaining alone can identify complete hydatidiform moles, which lack p57 expression because of a lack of maternal DNA, this analysis does not distinguish partial hydatidiform moles from nonmolar specimens because both express p57 because of the presence of maternal DNA. Genotyping, which compares villous and decidual DNA patterns to determine the parental source and ratios of polymorphic alleles, distinguishes purely androgenetic complete hydatidiform moles from diandric triploid partial hydatidiform moles, and both of these from biparental nonmolar specimens. An algorithmic approach to diagnosis using these techniques is advocated.

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Successful Primary Treatment of a Hydatidiform Mole with Methotrexate and EMA/CO

Case Reports in Medicine ◽

10.1155/2009/454161 ◽

2009 ◽

Vol 2009 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

M. De Vos ◽

M. Leunen ◽

C. Fontaine ◽

Ph. De Sutter

Keyword(s):

Surgical Treatment ◽

Complete Remission ◽

Treatment Option ◽

Hydatidiform Mole ◽

Uterine Fibroids ◽

Treatment Method ◽

Primary Treatment ◽

Molar Pregnancy ◽

Complete Hydatidiform Mole ◽

Hydatidiform Moles

Background. The preferred treatment method of most hydatidiform moles is suction aspiration. In rare circumstances uterine abnormalities may preclude surgical treatment.Case. We report a case of complete molar pregnancy successfully treated with methotrexate followed by EMA/CO. A 38-year-old woman with a complete hydatidiform mole and multiple uterine fibroids underwent a failed attempt at suction aspiration. Following treatment with methotrexate, a nonmetastatic persistent trophoblastic tumour developed. Six cycles of EMA/CO led to complete remission.Conclusion. We propose that primary treatment of molar pregnancies with chemotherapy is a useful treatment option in cases where uterine abnormalities interfere with suction aspiration.

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Expression of Pro-Apoptotic Bax and Anti-Apoptotic Bcl-2 Proteins in Hydatidiform Moles and Placentas With Hydropic Changes

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i1.1750 ◽

2019 ◽

Author(s):

Alireza Khooei ◽

Fatemeh Atabaki Pasdar ◽

Alireza Fazel ◽

Mahmoud Mahmoudi ◽

Mohammad Reza Nikravesh ◽

...

Keyword(s):

Differential Diagnosis ◽

Diagnostic Tool ◽

Stromal Cells ◽

Hydatidiform Mole ◽

Complete Hydatidiform Mole ◽

Tissue Samples ◽

Partial Hydatidiform Mole ◽

Significant Difference ◽

Hydropic Abortion ◽

Hydatidiform Moles

Abstract- Morphologic examination still forms the main diagnostic tool in the differential diagnosis of molar placentas. However the criteria are subjective and show considerable inter-observer variability among pathologists. The aim of the present study was to investigate the role of Bcl-2 and Bax immunostaining in the differential diagnosis of molar placentas. Bax and Bcl-2 immunohistochemical staining were performed in 19 molars (8 partial and 11 complete hydatidiform mole) and 10 non-molar (hydropic abortion) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry had confirmed diploidy in hydropic abortions and complete hydatidiform moles and triploidy in partial hydatidiform moles. Bcl-2 expression was observed only in syncytiotrophoblasts, No immunoreactivity was detected in Cytotrophoblasts, and stromal cells, the total score averages of Bcl-2 immunoexpression in partial hydatidiform moles and hydropic abortions were significantly higher than in complete hydatidiform moles, whereas no significant difference was observed between partial hydatidiform moles and hydropic abortions. Bax immunoreactivity was observed in cytotrophoblasts, stromal cells and occasionally in syncytiotrophoblasts. No statistically significant difference in Bax immunoexpression total score was observed among various groups. Based on the results of this study, Bcl-2 immunostaining offers a potential adjunctive diagnostic tool to distinguish complete hydatidiform mole from partial hydatidiform mole and hydropic abortion, but not partial hydatidiform mole from hydropic abortion, Bax immunostaining cannot be helpful in this regard.

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A case report pemphigoid gestational case, responding to systemic steroid therapy

Journal of Clinical Case Reports and Studies ◽

10.31579/2690-8808/060 ◽

2021 ◽

Vol 2 (2) ◽

pp. 01-05

Author(s):

Selma Bakar Dertlioğlu

Keyword(s):

Case Report ◽

Mononuclear Cells ◽

Skin Lesions ◽

Complement C3 ◽

Direct Immunofluorescence ◽

Systemic Steroid ◽

Pemphigoid Gestationis ◽

Bullous Dermatosis ◽

Systemic Steroid Therapy ◽

Histopathologic Findings

In this case report, a rare case of Pemphigoid Gestationis at 33 weeks’ of gestation is presented and the related literature is briefly reviewed. A 21-year-old at 33 weeks’ of gestation admitted with the complain of itchy skin lesions on the abdomen, arms and legs. Dermatologic examination revealed urticaria papules and plaques in the abdomen, arms and legs, more intensely around the umbilicus, which range from 1-2 cm diameter to 4-5 cm diameter. Papulovesicular lesions and few erosions were observed especially in the hand and foot dorsals. Spongiosis on epidermis, intracellular and subepidermal bullae formation, edema on papillary architecture and inflammatory infiltrate composed of mononuclear cells and eosinophils around the perivascular ares of the upper dermis were seen in histological examination. Direct immunofluorescence of perilesional skin showed linear deposition of complement (C3) along the basement membrane zone. The preliminary diagnosis of pemphigoid gestationis was confirmed by histopathologic findings. Pemphigoid gestationis is a rare autoimmune bullous dermatosis that begins in the second or third trimester of pregnancy. Healing occurs weeks after birth. It occurs more severely in subsequent pregnancies. Its main treatment is systemic steroid and antihistamine administration. A multidisciplinary approach both in dermatological and gynecological terms is required for the diagnosis, treatment and course of the disease.

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Centralized surveillance of hydatidiform mole: 7-year experience from a regional hospital in China

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-002797 ◽

2021 ◽

pp. ijgc-2021-002797

Author(s):

Lanzhou Jiao ◽

Yaping Wang ◽

Jiyong Jiang ◽

Xiuying Wang ◽

Wenqing Zhang ◽

...

Keyword(s):

High Risk ◽

Hydatidiform Mole ◽

Single Agent ◽

Regional Hospital ◽

Low Risk ◽

Gestational Trophoblastic Neoplasia ◽

Complete Hydatidiform Mole ◽

Gynecology And Obstetrics ◽

Prophylactic Chemotherapy ◽

Hydatidiform Moles

ObjectiveTo assess the strategy and value of centralized surveillance of hydatidiform mole at a regional hospital in China and to investigate the necessity of prophylactic chemotherapy for high-risk complete hydatidiform mole.MethodsBetween February 2013 and February 2020, all women with hydatidiform mole in Dalian Women’s and Children’s Medical Center (Group) were registered for surveillance and treatment when indicated. Women with complete hydatidiform mole were categorized into low-risk and high-risk groups according to the criteria from Song Hongzhao’s trophoblastic neoplasia. Outcomes and treatments were analyzed retrospectively.ResultsIn total, 703 women with hydatidiform mole were registered for surveillance with a follow-up rate of 97.9% (688/703). 680 women were enrolled and 52 (7.6%) developed post-molar gestational trophoblastic neoplasia, all with low-risk International Federation of Gynecology and Obstetrics (FIGO) scores 0–5. Post-molar gestational trophoblastic neoplasia was diagnosed in 12.3% (51/413) of patients with complete hydatidiform moles and 0.4% (1/263) of patients were diagnosed with partial hydatidiform moles (χ2=32.415, p<0.001). Post-molar gestational trophoblastic neoplasia was diagnosed in 27.7% (28/101) of the high-risk complete hydatidiform mole group and in 7.4% (23/312) of the low-risk complete hydatidiform mole group (χ2=29.196, p<0.001). No difference in the pre-treatment assessments of patients with post-molar gestational trophoblastic neoplasia was found between the low-risk and high-risk complete hydatidiform mole groups (all p>0.05). All 52 patients with post-molar gestational trophoblastic neoplasia were cured, with a complete response rate of 61.2% (30/49) with first-line single-agent chemotherapy.ConclusionsA centralized hydatidiform mole surveillance program is feasible and effective and may improve the prognosis of patients with post-molar gestational trophoblastic neoplasia. Prophylactic chemotherapy is not recommended for women with high-risk complete hydatidiform mole with adequate surveillance.

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ABO Genotyping of Complete Hydatidiform Moles

Disease Markers ◽

10.1155/1993/750349 ◽

1993 ◽

Vol 11 (4) ◽

pp. 179-185 ◽

Cited By ~ 1

Author(s):

R. A. Fisher ◽

P. H. Johnson ◽

S. Povey ◽

D. A. Hopkinson ◽

S. D. Lawler

Keyword(s):

Blood Group ◽

Blood Cells ◽

Hydatidiform Mole ◽

Abo Blood Group ◽

Complete Hydatidiform Mole ◽

Molecular Genotyping ◽

Partner Influence ◽

Abo Genotype ◽

The Relationship ◽

Hydatidiform Moles

It has been suggested that the ABO blood group of a patient and her partner influence the clinical outcome for patients having a pregnancy with a complete hydatidiform mole (CHM). Since CHM lack red blood Cells, it has not previously been possible to type CHM serologically and investigate the relationship between the blood group of the CHM and that of the patient. In the present study we have demonstrated the feasibility of using molecular genotyping to determine the ABO genotype of CHM, the ABO genotype being consistent with the androgenetic origin of CHM in all cases. In the series of 48 cases of CHM, the requirement for chemotherapy was not significantly different in those patients with a CHM of like blood group compared with those with a CHM of unlike blood group.

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Pemphigoid gestationis with a complete hydatidiform mole

The Journal of Dermatology ◽

10.1111/j.1346-8138.2011.01315.x ◽

2011 ◽

Vol 39 (5) ◽

pp. 474-476 ◽

Cited By ~ 3

Author(s):

Yuka TAKATSUKA ◽

Mayumi KOMINE ◽

Mamitaro OHTSUKI

Keyword(s):

Hydatidiform Mole ◽

Complete Hydatidiform Mole ◽

Pemphigoid Gestationis

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Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital

Obstetrics and Gynecology International ◽

10.1155/2018/9561413 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Olivier Mulisya ◽

Drucilla J. Roberts ◽

Elizabeth S. Sengupta ◽

Elly Agaba ◽

Damaris Laffita ◽

...

Keyword(s):

Gestational Age ◽

Maternal Age ◽

Hydatidiform Mole ◽

Advanced Maternal Age ◽

First Trimester ◽

Complete Hydatidiform Mole ◽

Regional Referral Hospital ◽

Factors Associated ◽

History Of ◽

Hydatidiform Moles

Objective. We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda. Methods. This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obstetrics, and gynecological factors. The evacuated tissue received a full gross and histopathologic examination. Cases of pathologically suspected complete hydatidiform mole were confirmed by p57 immunohistochemistry. Data were analyzed using STATA 13. Results. The prevalence of hydatidiform mole was 6.1% (11/181). All detected moles were complete hydatidiform moles, and there were no diagnosed partial hydatidiform moles. Clinical diagnosis of molar pregnancy was suspected in 13 patients, but only 69.2% (9/13) were confirmed as molar pregnancies histologically. Two cases were clinically unsuspected. Factors that had a significant relationship with complete hydatidiform mole included maternal age of 35 years and above (aOR 13.5; CI: 1.46–125.31; p=0.00), gestational age beyond the first trimester at the time of uterine evacuation (aOR 6.2; CI: 1.07–36.14; p=0.04), and history of previous abortion (aOR 4.3; CI: 1.00–18.57; p=0.05). Conclusion. The prevalence of complete hydatidiform mole was high at 6.1%. Associated risk factors included advanced maternal age (35 years and above), history of previous abortions, and gestational age beyond the first trimester at the time of evacuations. Recommendations. We recommend putting in place capacity to do routine histopathological examination of all products of conception especially those at high risk for a molar gestation either by clinical suspicion or by risk factors including advanced maternal age, advanced gestational age, and history of previous abortion because of high prevalence of complete mole.

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