Invasive Mole

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Invasive Mole

  1. 1. INVASIVE MOLE<br />Dr. Margarita Isabel Amoroso-Artes<br />Department of OB/GYN<br />
  2. 2. Definition<br />Molar pregnancy <br />ChorioadenomaDestruens<br />Molar villi grow into the myometrium or its blood vessels<br />May extend into the broad ligament and metastasize to the lungs, the vagina or the vulva.<br />
  3. 3. All cases of invasive mole are sequelae of hydatidiform moles<br />Approximately 15% of complete moles are associated with or precede invasive moles<br />The pathologic diagnosis of invasive mole is rarely made because most cases are treated medically, without hysterectomy<br />
  4. 4. CLINICAL FEATURES<br />PERSISTENT HEMORRHAGE<br />UTERINE PERFORATION<br />
  5. 5. Vascular invasion may result in trophoblastic nodules in sites outside the uterus, such as: <br />vagina<br />lungs <br />
  6. 6. Hydropicvilli covered by proliferating trophoblast are seen permeating the myometrium in this invasive mole<br />
  7. 7. Gross appearance of invasive mole. A hemorrhagic mass has permeated half of the thickness of the myometrial wall.<br />
  8. 8. Whole-mount view of invasive mole. Abnormal villi are seen permeating the thickened myometrium (arrows).<br />
  9. 9. Invasive mole vs complete mole<br />DIFFERENTIALS<br />
  10. 10. Large villi with stromaledema and marked trophoblastic proliferation<br />Diagnostic Pearls<br />Nearly all of the villi show hydropic degeneration appearing as a &apos;bunch of grapes&apos;, vesicles measure 1 to 30 mm, and no embryo, fetus , membranes or cord is seen <br />There is vesicular swelling of the villi and hyperplasia of the trophoblast<br />Trophoblastic hyperplasia has a circumferential arrangement around each villi<br />Abnormal villi with proliferating trophoblast invading the myometrium<br />Diagnostic Pearls<br />Hemorrhagic mass permeating the myometrial wall <br />Abnormal villi are seen permeating the myometrial wall or inside blood vessels <br />The vascular invasion may result in nodules outside the uterus <br />
  11. 11. INVASIVE MOLE VS PARTIAL MOLE<br />DIFFERENTIALS<br />
  12. 12. Scalloping of the villi and pseudoinclusion of trophoblastic tissue<br />Diagnostic Pearls<br />Less placental tissue than in complete mole, with a mixture of normal villi and large vesicles, an embryo or a fetus may be found <br />Mixture of large and small villi, with focal edema to cisterna formation <br />Many of the villi have an irregular, scalloped outline and contain vessels with fetal red blood cells <br />Abnormal villi with proliferating trophoblast invading the myometrium<br />Diagnostic Pearls<br />Hemorrhagic mass permeating the myometrial wall <br />Abnormal villi are seen permeating the myometrial wall or inside blood vessels <br />The vascular invasion may result in nodules outside the uterus <br />
  13. 13. INVASIVE MOLE VS CHORIOCARCINOMA<br />DIFFERENTIALS<br />
  14. 14. Admixture of syncytiotrophoblast and cytotrophoblast is seen in this example<br />Diagnostic Pearls<br />Clusters of cytotrophoblast separated by streaming masses of syncytiotrophoblast, with a characteristic dimophicplexiform pattern <br />Villi formation must be absent <br />Vascular invasion is commonly found and may be extensive<br />Abnormal villi with proliferating trophoblast invading the myometrium<br />Diagnostic Pearls<br />Hemorrhagic mass permeating the myometrial wall <br />Abnormal villi are seen permeating the myometrial wall or inside blood vessels <br />The vascular invasion may result in nodules outside the uterus <br />
  15. 15. Figo Staging<br />
  16. 16. MANAGEMENT<br />CHEMOTHERAPY PRIMARILY<br />
  17. 17. Stage I, Stage II-III low risks patients<br />Single Agent every 7- 10 days<br />2 clean-up courses after the first normal titer<br />Discontinue Chemotherapy/shifted to another regimen: (actinomycin D)<br />(+) toxicity<br />Drug resistance<br />
  18. 18. Stage II-III, High Risk<br />Combination of chemotherapy q 14 days, until hCG titer is normal<br />EMACO (Etoposide, Metothrexate, Actinomycin, Oncovin), MEA<br />3 clean-up courses<br />
  19. 19. Stage IV patients<br />Initial combination chemotherapy q 14 days<br />3 clean up courses after the 1st normal titer<br />IF with Brain mets<br />Intrathecalmetothrexate<br />12.5 mg <br />Steroids or Mannitol<br />For brain decompression<br />

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