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VesicularMole-abdalla - Vesicular Mole Dr MOHAMMED ABDALLA...

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Vesicular Mole Dr. MOHAMMED ABDALLA EGYPT, DOMIAT G. HOSPITAL
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It is a benign neoplasm of the chorionic villi
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Incidence: 1:2000 pregnancies in United States and Europe 1:200 in Asia 10 times more in women over 45 years old. The increasing use of ultrasound in early pregnancy has probably led to the earlier diagnosis of molar pregnancy
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1-Maternal age : Young mothers (under age 20 years) have a slightly higher prevalence of GTD, although not nearly so great as those mothers over age 35 years. 2-Women who have had a previous molar gestation 3-The risk increases with the number of spontaneous abortions . 4- Women with blood type A may be more likely to develop choriocarcinoma (but not hydatidiform mole); RISK FACTORS:
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What Is A Hydatidiform Mole? A hydatidiform mole is an abnormality of fertilization It is the result of fertilisation of anucleated ovum ( has no chromosomes) with a sperm which will duplicate giving rise to 46 chromosomes of paternal origin only. It is the result of fertilisation of an ovum by 2 sperms so the chromosomal number is 69 chromosomes COMPLETE MOLE PARTIAL MOLE
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Differentiation Between Complete And Partial Mole Feature Complete Mole Partial Mole Embryonic or foetal tissue Absent Present Swelling of the villi Diffuse Focal Trophoblastic hyperplasia Diffuse Focal Karyotype Paternal 46 XX (96%) or 46 XY (4%) Paternal and maternal 69 XXY or 69 XYY Malignant Changes 5-10% Rare
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Three components make up the trophoblast: cytotrophoblast, syncytiotrophoblast intermediate trophoblast The cytotrophoblast is a stem cell with high mitotic activity but without hormonal synthesis. The syncytiotrophoblast, which constitutes the villous trophoblast, has low mitotic activity. The syncytiotrophoblast is responsible for the synthesis of the (beta-hCG) and can be identified with immunohistochemical stains. The intermediate trophoblast has features of the other two components and is responsible for endometrial invasion and implantation
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There is trophoblastic proliferation, with mitotic activity affecting both syncytial and cytotrophoblastic layers. This causes excessive secretion of hCG,chorionic thyrotrophin and progesterone. . Pathology microscopic evaluation shows trophoblastic hyperplasia
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( hydropic) villi The uterus is distended by thin walled, translucent, grape-like vesicles of different sizes. At histologic analysis , Uniformly edematous (hydropic) villi with dissolution of central stroma (cavitation/cistern Pathology
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There is no vasculature in the chorionic villi leads to early death and absorption of the embryo. At histologic analysis Occasionally, necrosis is seen Pathology
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High hCG causes: multiple theca lutein cysts in the ovaries in about 50% of cases. exaggeration of the normal early pregnancy symptoms and signs Pathology
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1.Uniformly edematous (hydropic) villi with dissolution of central stroma (cavitation/cistern) 2.Villous vessels absent (usually) 3.Trophoblastic hyperplasia – circumferential, haphazard, involves CT/ST/IT 4.Trophoblastic atypia Pathology
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Symptoms and Signs Usually occur in first 20 - 24 weeks of gestation.
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