Ultrasound Diagnosis of Coexisting Molar Pregnancy Following Referral for Abnormal Serum Screen

Abstract

Complete hydatidiform mole and coexistent fetus is a rare occurrence. We report a case of a patient referred for abnormal serum screen and vaginal bleeding in the second trimester of pregnancy. Ultrasound revealed a cystic and solid mass along the posterior uterine wall with multiple hypoechoic (honeycomb) areas noted, consistent with molar degeneration of the placenta. Separate from this mass was a coexisting viable fetus with normal fetal anatomy and distinct anterior placenta. At delivery, a large cystic mass of placental tissue appeared to be implanted separately from a normal-appearing fetus and placenta. The mass weighed 184 g and contained multiple 1- to 1.5-cm cysts throughout. Microscopic sections revealed hydropic chorionic villi with central cistern formation and nonpolar trophoblastic hyperplasia with atypia, compatible with complete hydatidiform mole. This case illustrates that the diagnosis of coexisting molar pregnancy after referral for abnormal serum screen should be considered, especially if maternal serum beta-human chorionic gonadotropin is high and the patient has vaginal bleeding.

Fetal Thrombotic Vasculopathy in Twin Placentas with Complete Hydatidiform Mole

“…One of the coexistent fetuses died in utero, and the other 2 delivered prematurely. There are numerous reports in the literature of twin pregnancy complicated by complete hydatidiform mole [4][5][6][7][8]. However, apart from the villous morphologic changes and molecular features of complete mole, the histology of these molar twin placentas is rarely studied.…”