Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia.
Am J Case Rep. 2021 Jun 15;22:e931156. doi: 10.12659/AJCR.931156.
BACKGROUND Gestational trophoblastic disease (GTD) is a spectrum of disorders consisting of premalignant (ie, complete [CHM] and partial hydatidiform moles [PHM]) and malignant conditions (ie, invasive moles, choriocarcinoma, placental site trophoblastic tumors, and epithelioid trophoblastic tumor). If GTD persists after initial treatment and has persistent elevated beta human chorionic gonadotropin (ß-hCG), it is referred to as post-molar gestational trophoblastic neoplasia (pGTN). To date, there is no detailed information regarding how fast invasive moles can develop from CHM. However, the risk of developing any pGTN from CHM is rare within 1 month and is greatest in the first 12 months after evacuation, with most cases presenting within 6 months. CASE REPORT We present a case of a 46-year-old primigravida woman with rapid transformation of an invasive mole. In the beginning, the patient had a chief concern of a uterus size greater than the gestational dates. Laboratory evaluation showed high ß-hCG serum level (>300 000 mIU/mL), and ultrasonography evaluation revealed a hydatidiform mole. Suction evacuation and curettage procedures were then performed. Pathology evaluation afterwards revealed a complete hydatidiform mole without any sign of malignancy. Twenty-two days afterwards, the patient came to the emergency room with vaginal bleeding. ß-hCG serum level was high (53 969 mIU/mL), and ultrasonography examination showed the presence of fluid filling the uterine cavity. The patient was then diagnosed with GTN, and hysterectomy was chosen as the treatment of choice. After the surgery, her ß-hCG serum level gradually reverted back to normal. CONCLUSIONS Invasive moles can develop less than 1 month after suction evacuation and curettage procedure for CHM. Serial ß-hCG serum level evaluation according to the guideline should be performed to prevent late diagnosis, which could lead to the development of metastasis and worsen the prognosis.
妊娠滋养细胞疾病（GTD）是一组疾病，包括良性（即完全性[CHM]和部分性葡萄胎[PHM]）和恶性疾病（即侵袭性葡萄胎、绒毛膜癌、胎盘部位滋养细胞肿瘤和上皮样滋养细胞肿瘤）。如果初始治疗后 GTD 持续存在且β人绒毛膜促性腺激素（β-hCG）持续升高，则称为葡萄胎后滋养细胞肿瘤（pGTN）。迄今为止，关于 CHM 从良性到侵袭性葡萄胎的转化速度尚无详细信息。然而，在 1 个月内从 CHM 发展为任何 pGTN 的风险很小，在清宫后 12 个月内风险最大，大多数病例在 6 个月内出现。
我们报告了一例 46 岁初产妇快速转化为侵袭性葡萄胎的病例。起初，患者子宫大小大于孕周，主要关注的是子宫大小。实验室检查显示血清β-hCG 水平升高（>300 000 mIU/mL），超声检查显示葡萄胎。随后进行了吸宫和刮宫术。随后的病理检查显示为完全性葡萄胎，无任何恶性迹象。22 天后，患者因阴道出血就诊于急诊科。血清β-hCG 水平升高（53 969 mIU/mL），超声检查显示宫腔内有液体填充。患者随后被诊断为 GTN，选择子宫切除术作为治疗方法。手术后，她的β-hCG 血清水平逐渐恢复正常。
在 CHM 吸宫和刮宫术后不到 1 个月，侵袭性葡萄胎可能会发生。应根据指南进行连续的β-hCG 血清水平评估，以防止诊断延迟，从而导致转移和预后恶化。
