Abnormal Development - Hydatidiform Mole
|Embryology - 22 Jun 2018 Expand to Translate|
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- 1 Introduction
- 2 Some Recent Findings
- 3 International Classification of Diseases
- 4 Mole Types
- 5 Diagnostic
- 6 Tumour Growth
- 7 Choriocarcinoma
- 8 Placental Mesenchymal Dysplasia
- 9 Twin Pregnancy Mole
- 10 Ectopic Molar Pregnancy
- 11 References
- 12 Additional Images
- 13 External Links
- 14 Glossary Links
(hydatidiform mole, hydatid mole, molar pregnancy, gestational trophoblastic disease) A type of fertilisation abnormality, when only the conceptus trophoblast layers proliferates and not the embryoblast, no embryo develops, this is called a "hydatidiform mole". Due to the continuing presence of the trophoblastic layer, this abnormal conceptus can also implant in the uterus or ectopically. The trophoblast cells will secrete human chorionic gonadotropin (hCG), as in a normal pregnancy, and may appear maternally and by pregnancy test to be "normal". Prenatal diagnosis by ultrasound analysis demonstrates the absence of a embryo.
- Complete Mole - Only paternal chromosomes.
- Partial Mole - 3 sets of chromosomes ( (triploidy) instead of the usual 2.
There are several forms of hydatidiform mole: partial mole, complete mole and persistent gestational trophoblastic tumor. Many of these tumours arise from a haploid sperm fertilizing an egg without a female pronucleus (the alternative form, an embryo without sperm contribution, is called parthenogenesis). The tumour has a "grape-like" placental appearance without enclosed embryo formation. Following a first molar pregnancy, there is approximately a 1% risk of a second molar pregnancy.
- The incidence of hydatidiform mole varies between ethnic groups, and typically occurs in 1 in every 1500 pregnancies.
- All hydatidiform mole cases are sporadic, except for extremely rare familial cases.
- A maternal gene has been identified for recurrent hydatidiform mole (chromosome 19q13.3-13.4 in a 15.2 cM interval flanked by D19S924 and D19S890).
Some Recent Findings
|More recent papers|
This table shows an automated computer PubMed search using the listed sub-heading term.
References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability.
Christophe Desterke, Rima Slim, Jean-Jacques Candelier A bioinformatics transcriptome meta-analysis highlights the importance of trophoblast differentiation in the pathology of hydatidiform moles. Placenta: 2018, 65;29-36 PubMed 29908639
B Kaur, N J Sebire ##Title## BJOG: 2018; PubMed 29904999
Pierre-Adrien Bolze, Mélodie Mathe, Touria Hajri, Benoit You, Yohann Dabi, Anne-Marie Schott, Sophie Patrier, Jérôme Massardier, François Golfier First-line hysterectomy for women with low-risk non-metastatic gestational trophoblastic neoplasia no longer wishing to conceive. Gynecol. Oncol.: 2018; PubMed 29887485
Houssine Boufettal, Naïma Samouh Invasive hydatidiform mole in the cervix. Pan Afr Med J: 2018, 29;27 PubMed 29875909
Yuto Maeda, Ruriko Oyama, Hirona Maeda, Yukihiro Imai, Shinya Yoshioka Choriocarcinoma with multiple lung metastases from complete hydatidiform mole with coexistent fetus during pregnancy. J. Obstet. Gynaecol. Res.: 2018; PubMed 29845692
International Classification of Diseases
Use additional code from category O08.-, if desired, to identify any associated complication.
Excl.: malignant hydatidiform mole (D39.2)
- O01.0 - Classical hydatidiform mole
- Complete hydatidiform mole
- O01.1 - Incomplete and partial hydatidiform mole
- O01.9 - Hydatidiform mole, unspecified
- Trophoblastic disease NOS
- Vesicular mole NOS
- O08 - Complications following abortion and ectopic and molar pregnancy
Note: This code is provided primarily for morbidity coding. For use of this category reference should be made to the morbidity coding rules and guidelines in Volume 2.
- D39.2 8 Placenta
- Chorioadenoma destruens
- Hydatidiform mole:
Excl.: hydatidiform mole NOS (O01.9)
Only paternal chromosomes.
- Chromosomal genetic material from the ovum (egg) is lost, by an unknown process.
- Fertilization then occurs with one or two sperm and an androgenic (from the male only) conceptus (fertilized egg) is formed.
- With this conceptus the embryo (fetus, baby) does not develop at all but the placenta does grow.
- placenta it is abnormal and forms lots of cysts and has no blood vessels.
- These cysts look like a cluster of grapes and that is why it is called a hydatidiform ("grape-like") mole.
- A hydatidiform mole miscarries by about 16 to 18 weeks gestational age.
- Since the diagnosis can be made by ultrasound before that time, it is better to have an evacuation of the uterus (D & C) so that there is no undue bleeding and no infection.
- Human chorionic gonadotropin (hCG) levels will assist in making the diagnosis.
Three sets of chromosomes instead of the usual two and this is called triploidy.
- chromosomal (genetic) material from the ovum (egg) is retained and the egg is fertilized by one or two sperm.
- with partial mole there are maternal chromosomes and there is a fetus.
- the three sets of chromosomes means the fetus is always grossly abnormal and will not survive.
(Text modified from: International Society for the Study of Trophoblastic Diseases, see also JRM Gestational Trophoblastic Disease)
- Ultrasound can indicate the absence of an embryonic heartbeat and a "bunch of grapes" appearance.
- HCG level (>100000 mIU/ml)
- Excessive uterine enlargement
- Theca lutein cyst size ≥6 cm are considered a high risk for developing post molar tumors
A recent retrospective study of a large patient cohort identified clinical characteristics (table below) between the complete and partial hydatidiform moles types. After mole evacuation most patients in both groups reach normal serum hCG concentrations within 14 weeks.
|Mole Type||Average serum hCG||Post hCG normalization||Gestational age|
|complete||4400 ng/mL||7 weeks||11.5 weeks|
|partial||875 ng/mL||6 weeks||13.0 weeks|
Like any tumour, unless removed there is a risk of progression:
- Stage I: Tumor confined to uterus (non-metastatic)
- Stage II: Tumor involving pelvic organs and/or vagina
- Stage III: Tumor involving lungs, with or without involving pelvic structures and/or vagina
- Stage IV: Tumor involving distant organs
|Uterine and ovarian metastasis||Pulmonary metastasis|
A highly malignant epithelial tumour often associated with hydatidiform mole.
Placental Mesenchymal Dysplasia
A rare disorder due to a similar "grape-like" placental appearance, this rare disorder has been mistaken both clinically and macroscopically for a partial hydatidiform molar pregnancy. Characterized by an increased size placenta with cystic villi and dilated vessels. This disorder also has a high incidence of intrauterine growth restriction (IUGR) and fetal death.
Twin Pregnancy Mole
Hydatidiform mole and co-existent healthy fetus is a very rare condition with only 30 cases documented in detail in the literature.
Ectopic Molar Pregnancy
Left-sided unruptured ampullary ectopic pregnancy at laparoscopy.
- Links: Ectopic Implantation
- Moglabey YB, Kircheisen R, Seoud M, El Mogharbel N, Van den Veyver I & Slim R. (1999). Genetic mapping of a maternal locus responsible for familial hydatidiform moles. Hum. Mol. Genet. , 8, 667-71. PMID: 10072436
- Chan KK, Wong ES, Wong OG, Ngan HY & Cheung AN. (2018). Identification of nonsynonymous TP53 mutations in hydatidiform moles. Mutat. Res. , 809, 20-23. PMID: 29655027 DOI.
- Shaaban AM, Rezvani M, Haroun RR, Kennedy AM, Elsayes KM, Olpin JD, Salama ME, Foster BR & Menias CO. (2017). Gestational Trophoblastic Disease: Clinical and Imaging Features. Radiographics , 37, 681-700. PMID: 28287945 DOI.
- Eagles N, Sebire NJ, Short D, Savage PM, Seckl MJ & Fisher RA. (2015). Risk of recurrent molar pregnancies following complete and partial hydatidiform moles. Hum. Reprod. , 30, 2055-63. PMID: 26202916 DOI.
- Singer H, Biswas A, Nuesgen N, Oldenburg J & El-Maarri O. (2015). NLRP7, Involved in Hydatidiform Molar Pregnancy (HYDM1), Interacts with the Transcriptional Repressor ZBTB16. PLoS ONE , 10, e0130416. PMID: 26121690 DOI.
- Cole LA. (2012). Minimally-aggressive gestational trophoblastic neoplasms. Gynecol. Oncol. , 125, 145-50. PMID: 22198244 DOI.
- Aguilera M, Rauk P, Ghebre R & Ramin K. (2012). Complete hydatidiform mole presenting as a placenta accreta in a twin pregnancy with a coexisting normal fetus: case report. Case Rep Obstet Gynecol , 2012, 405085. PMID: 22928132 DOI.
- Kinare A. (2008). Fetal environment. Indian J Radiol Imaging , 18, 326-44. PMID: 19774194 DOI.
- Eysbouts Y, Brouwer R, Ottevanger P, Massuger L, Sweep F, Thomas C & van Herwaarden A. (2017). Serum Human Chorionic Gonadotropin Normogram for the Detection of Gestational Trophoblastic Neoplasia. Int. J. Gynecol. Cancer , 27, 1035-1041. PMID: 28498241 DOI.
- Aminimoghaddam S & Maghsoudnia A. (2017). Unusual Presentation of Invasive Mole: A Case Report. J Reprod Infertil , 18, 205-209. PMID: 28377901
- Piura B, Rabinovich A, Hershkovitz R, Maor E & Mazor M. (2008). Twin pregnancy with a complete hydatidiform mole and surviving co-existent fetus. Arch. Gynecol. Obstet. , 278, 377-82. PMID: 18273627 DOI.
- Bousfiha N, Erarhay S, Louba A, Saadi H, Bouchikhi C, Banani A, El Fatemi H, Sekkal M & Laamarti A. (2012). Ectopic molar pregnancy: a case report. Pan Afr Med J , 11, 63. PMID: 22655097
Kani KK, Lee JH, Dighe M, Moshiri M, Kolokythas O & Dubinsky T. (2012). Gestatational trophoblastic disease: multimodality imaging assessment with special emphasis on spectrum of abnormalities and value of imaging in staging and management of disease. Curr Probl Diagn Radiol , 41, 1-10. PMID: 22085657 DOI.
Cavaliere A, Ermito S, Dinatale A & Pedata R. (2009). Management of molar pregnancy. J Prenat Med , 3, 15-7. PMID: 22439034
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- PubMed Health Hydatidiform mole
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- The Journal of Reproductive Medicine Gestational Trophoblastic Disease (1998)
- Dana-Farber Cancer Institute Gynecologic Oncology Program
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Cite this page: Hill, M.A. (2018, June 22) Embryology Abnormal Development - Hydatidiform Mole. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Hydatidiform_Mole
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