A case report on complete hydatidiform mole coexisting with a diploid twin fetus
leading to gestational trophoblastic neoplasm
V.J. Meegoda1, K.G. Hewawitharana1, W.F.N. Fereen1, M A A M Jayawardane1, 2
1University professorial unit of Obstetrics & Gynecology, Colombo South Teaching Hospital., Colombo, Sri Lanka, 2Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
INTRODUCTION
•Complete mole coexisting with a twin fetus (CMCF) is an exceedingly rare condition that poses diagnostic & therapeutic challenges.
•Ultrasound is vital in making an early diagnosis, and the continuation of pregnancy is a multidisciplinary decision based on many factors, as there’s an increased risk of feto-maternal morbidity & mortality.
CASE PRESENTATION
•A 41 year old primigravida was incidentally diagnosed with CMCF at 8 weeks of gestation during early pregnancy scan.
•She was explained the findings, however she insisted on continuing pregnancy.
•She later presented with severe vaginal bleeding at 14 weeks, which led to suction-evacuation of the uterus, as a life saving measure.
•Routine postnatal monitoring revealed a drop followed by a rise of serum β-hCG at eight weeks which led to the diagnosis of GTN with pulmonary metastases.
•MDT decision was based on FIGO scoring system – Stage III, score 6, for which she was treated with single-agent chemotherapy with a satisfactory response.
DISCUSSION '
•Two mechanisms of dizygotic twins with molar pregnancy are possible. A normal diploid fetus can coexist with either a complete mole (all paternal in origin) or a partial mole(PM) (triploid, maternal or paternal in origin). Our patient had the former, a CMCF. This occurs when an empty egg is fertilized by a sperm, which leads to isolated duplication of paternal genetic material.
•Diagnosis is primarily based on ultrasound. A normal-looking fetus of appropriate dimensions for gestation, together with an aberrant cystic mass, is likely to be CMCF.
•Unusual elevation of β-hCG and suggestive clinical features, including vaginal bleeding, the passage of vesicles, rapid abdominal enlargement, elevated blood pressure, preeclampsia, hyperemesis, and hyperthyroidism, are known presentations.
•Discrete guidelines are not yet established due to rarity & management remains controversial. Continuation of pregnancy should be decided after counselling the couple on all possible maternal & fetal complications.
•Surgery (suction evacuation) remains the mainstay of treatment. There’s controversy surrounding the extent of the surgery and fertility preservation in young women.
•Maternal complications occur in about 50%, including elevated BP with preeclampsia, hyperthyroidism, hyperemesis, and vaginal bleeding, which may end up in a hysterectomy & the probability of gestational trophoblastic neoplasm(GTN).
•Fetal complications include fetal growth restriction, miscarriages, intrauterine fetal demise, preterm labour & associated complications.
There’s approximately a 25–50% chance of live birth if pregnancy is permitted to continue until a reasonable level of maturity is reached
CONCLUSION
Early prenatal diagnosis, appropriate counseling, meticulous antepartum surveillance, and adequate postnatal follow-up can achieve satisfactory fetal and maternal outcomes in CMCF.
