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

Vesicular Mole
Dr. MOHAMMED ABDALLA
EGYPT, DOMIAT G. HOSPITAL

It is a benign neoplasm
of the chorionic villi

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

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:

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

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

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

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

(
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

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

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

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

Symptoms and Signs
Usually occur in first 20 - 24 weeks of gestation.