Therapeutic approach to the iatrogenic invasive mole: A report of two cases

Abstract

Introduction. Invasive mole, a form of gestational trophoblastic neoplasia (GTN), is defined as penetration of molar tissue into the myometrium and/or presence of extra-uterine metastases. An invasive mole arising from a complete hydatiform mole is more common than an invasive mole arising from the partial hydatiform mole. Dilatation and uterine evacuation and/or curettage (D&E/C) is the first step in managing molar pregnancy.Uterine perforation is the most serious complication of this procedure. A less common one is the false passage. Cases report. A 47-year-old woman was referred to our Clinic under the suspicion of GTN, with elevated serum hCG levels. Intraoperatively, a softened uterus with trophoblastic tissue arising from the uterine perforation was observed. Histopathological exam (HPE) of tissue obtained from hysterectomy confirmed an invasive mole as a result of uterine perforation made during D&E/C. A 32-year-old woman with vaginal bleeding, nausea, and high levels of serum hCG levels was admitted to our Clinic. After four D&E/C, and persistently high levels of serum bhCG levels, explorative laparotomy has been performed. A false passage created during D&E/C with necrotic and molar tissue was observed. The partial hydatidiform mole was confirmed by the HPE.Conclusion This is the second reported case in the literature of postmolar GTN as a result of iatrogenic perforation of the uterus, and also the first described case of postmolar GTN arising from a false passage, created as an iatrogenic complication of D&E/C. A national survey of iatrogenic events during the treatment of GTD is needed since these events could completely change the therapeutic strategies in managing GTD.

Cornual invasive hydatidiform mole: a rare case report and literature review

“…The pathogenesis of invasive mole arising from molar pregnancy remains unknown and etiologic risk factors that contribute to the development of invasive mole are unclear. Two previous reports have revealed a fascinating etiology, that is iatrogenic factors, such as uterine perforation and false passage, can lead to the transformation of invasive mole from molar tissues [ 11 , 12 ]. The best treatment option for invasive mole is chemotherapy and the cure rate is nearly 100% in low-risk patients and 90% in high-risk patient [ 13 ].…”