Page 686 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat
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642 SectioN iii RepRoductive ` REPRODUCTIVE—PATHOlOgy RepRoductive ` REPRODUCTIVE—PATHOlOgy
Hydatidiform mole Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast).
Presents with vaginal bleeding, emesis, uterine enlargement more than expected, pelvic pressure/
A
pain. Associated with hCG-mediated sequelae: early preeclampsia (before 20 weeks), theca-lutein
cysts, hyperemesis gravidarum, hyperthyroidism.
Treatment: dilation and curettage and methotrexate. Monitor hCG.
Complete mole Partial mole
KARyOTyPE 46,XX; 46,XY 69,XXX; 69,XXY; 69,XYY
COmPONENTS Most commonly enucleated egg 2 sperm + 1 egg
B + single sperm (subsequently
duplicates paternal DNA)
HISTOlOgy Hydropic villi, circumferential Only some villi are hydropic,
and diffuse trophoblastic focal/minimal trophoblastic
proliferation proliferation
FETAl PARTS No Yes (partial = fetal parts)
STAININg FOR P57 PROTEIN ⊝ (paternally imprinted) ⊕ (maternally expressed)
UTERINE SIZE —
hCg
ImAgINg “Honeycombed” uterus or Fetal parts
“clusters of grapes” A ,
“snowstorm” B on ultrasound
RISK OF INVASIVE mOlE 15–20% < 5%
RISK OF CHORIOCARCINOmA 2% Rare
Choriocarcinoma Rare; can develop during or after pregnancy B
in mother or baby. Malignancy of
A
trophoblastic tissue A (cytotrophoblasts,
syncytiotrophoblasts); no chorionic
villi present. frequency of bilateral/
multiple theca-lutein cysts. Presents with
abnormal hCG, shortness of breath,
hemoptysis. Hematogenous spread to lungs
“cannonball” metastases B .
Treatment: methotrexate.
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