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| {{Hydatiform mole}} | | {{Hydatiform mole}} |
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| | ==[[Hydatiform mole overview|Overview]]== |
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| ==Pathophysiology== | | ==[[Hydatiform mole historical perspective|Historical Perspective]]== |
| A mole is characterized by a [[conceptus]] of [[hyperplasia|hyperplastic]] [[trophoblast]]ic tissue attached to the [[placenta]]. The conceptus does not contain the [[inner cell mass]] (the mass of cells inside the primordial embryo that will eventually give rise to the fetus).
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| The hydatidiform mole can be of two types: a ''complete mole'', in which the abnormal embryonic tissue is derived from the father only; and a ''partial mole'', in which the abnormal tissue is derived from both parents.
| | ==[[Hydatiform mole classification|Classification]]== |
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| * '''Complete moles''' usually occur when an empty ovum is fertilized by a sperm that then duplicates its own DNA (a process called ''[[androgenesis]]''). This explains why most complete moles are of the 46,XX genotype. A 46, XY genotype may occur when 2 sperm (one 23, X and the other 23, Y) fertilize an empty egg. They grossly resemble a bunch of grapes ("cluster of grapes" or "honeycombed uterus" or "snow-storm"<ref>{{cite journal |author=Woo J, Hsu C, Fung L, Ma H |title=Partial hydatidiform mole: ultrasonographic features |journal=Aust N Z J Obstet Gynaecol |volume=23 |issue=2 |pages=103-7 |year=1983 |pmid=6578773}}</ref>). Their DNA is purely paternal in origin (since all chromosomes are derived from the sperm), and is [[diploid]] (i.e. there are two copies of every chromosome). Ninety percent are 46,XX, and 10% are 46,XY. In a complete mole, the fetus fails to develop, thus on gross examination there are no signs of fetal tissue. All of the [[chorionic villi]] are enlarged. The main complication of the complete mole is a 2% chance of progression to a cancer called [[choriocarcinoma]].
| | ==[[Hydatiform mole pathophysiology|Pathophysiology]]== |
| * '''Partial moles''' can occur if a normal [[haploid]] ovum is fertilized by two sperm, or, if fertilized by one sperm, if the paternal chromosomes become duplicated. Thus their DNA is both maternal and paternal in origin. They can be triploid (e.g. 69 XXX, 69 XXY) or even tetraploid. Fetal parts are often seen on gross examination. There is also an increased risk of choriocarcinoma, but the risk is lower than with the complete mole.
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| ==Etiology== | | ==[[Hydatiform mole causes|Causes]]== |
| The etiology of this condition is not completely understood. Potential risk factors may include defects in the egg, abnormalities within the [[uterus]], or nutritional deficiencies. Women under 20 or over 40 years of age have a higher risk. Other risk factors include diets low in [[protein]], [[folic acid]], and [[carotene]].
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| ==Treatment== | | ==[[Hydatiform mole differential diagnosis|Differentiating Hydatiform mole from other Diseases]]== |
| Hydatidiform moles should be treated by evacuating the uterus by uterine suction or by surgical [[curettage]] as soon as possible after diagnosis. Patients are followed up until their serum human chorionic gonadotrophin (hCG) titre has fallen to an undetectable level. Invasive or metastatic moles often respond well to [[methotrexate]]. The response to treatment is nearly 100%. Patients are advised not to conceive for one year after a molar pregnancy. The chances of having another molar pregnancy are approximately 1%.
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| ==Prognosis== | | ==[[Hydatiform mole epidemiology and demographics|Epidemiology and Demographics]]== |
| More than 80% of hydatidiform moles are benign. The outcome after treatment is usually excellent. Close follow-up is essential. Highly effective means of contraception are recommended to avoid pregnancy for at least 6 to 12 months.
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| In 10 to 15% of cases, hydatidiform moles may develop into invasive moles. These may intrude so far into the uterine wall that hemorrhage or other complications develop. It is for this reason that a post-operative full abdominal and chest x-ray will often be requested.
| | ==[[Hydatiform mole risk factors|Risk Factors]]== |
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| In 2 to 3% of cases, hydatidiform moles may develop into [[choriocarcinoma]], which is a malignant, rapidly-growing, and metastatic (spreading) form of cancer. Despite these factors which normally indicate a poor prognosis, the rate of cure after treatment with chemotherapy is high.
| | ==[[Hydatiform mole screening|Screening]]== |
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| Over 90% of women with malignant, non-spreading cancer are able to survive and retain their ability to have children. In those with metastatic (spreading) cancer, remission remains at 75 to 85%, although the ability to have children is usually lost.
| | ==[[Hydatiform mole natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==References== | | ==Diagnosis== |
| * Original source: http://www.nlm.nih.gov/medlineplus/ency/article/000909.htm
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| <references/>
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| ==External links==
| | [[Hydatiform mole history and symptoms|History and Symptoms]] | [[Hydatiform mole physical examination|Physical Examination]] | [[Hydatiform mole laboratory findings|Laboratory Findings]] | [[Hydatiform mole ultrasound|Ultrasound]] | [[Hydatiform mole other imaging findings|Other Imaging Findings]] | [[Hydatiform mole other diagnostic studies|Other Diagnostic Studies]] |
| *[http://www.springerlink.com/link.asp?id=w2555w4k4805h4h9 Complete moles have paternal chromosomes but maternal mitochondrial DNA] by Douglas C. Wallace, Urvashi Surti, Camellia W. Adams and A. E. Szulman, Volume 61, Number 2 of ''Human Genetics''
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| *[http://www.mymolarpregnancy.com MyMolarPregnancy.com] Support group, information, links and personal stories for women with molar pregnancies.
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| *[http://www.paternityangel.com/Articles_zone/EarlyLoss/EarlyLoss4.htm Molar Pregnancy] Early pregnancy loss
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| == Acknowledgements == | | ==Treatment== |
| The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.
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| List of contributors:
| | [[Hydatiform mole medical therapy|Medical Therapy]] | [[Hydatiform mole surgery|Surgery]] | [[Hydatiform mole primary prevention|Primary Prevention]] | [[Hydatiform mole secondary prevention|Secondary Prevention]] | [[Hydatiform mole cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hydatiform mole future or investigational therapies|Future or Investigational Therapies]] |
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| == Suggested Reading and Key General References == | | ==Case Studies== |
| | [[Hydatiform mole case study one|Case #1]] |
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| == Suggested Links and Web Resources ==
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| == For Patients == | | == Acknowledgements == |
| | | The content on this page was first contributed by: C. Michael Gibson, M.S., M.D. |
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| [[ar:حمل عنقودي]] | | [[ar:حمل عنقودي]] |