open access

Vol 91, No 10 (2020)
Research paper
Published online: 2020-10-30
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Twin pregnancy with a partial hydatidiform mole and a coexistent live fetus. Diagnostic and therapeutic dilemmas. A case report and the review of literature

Malgorzata Gajewska, Aleksandra Zygula, Miroslaw Wielgos, Grzegorz Szewczyk
DOI: 10.5603/GP.a2020.0109
·
Pubmed: 33184826
·
Ginekol Pol 2020;91(10):589-594.

open access

Vol 91, No 10 (2020)
ORIGINAL PAPERS Gynecology
Published online: 2020-10-30

Abstract

Objectives: We report the case of a twin pregnancy with a partial hydatidiform mole and a coexistent live fetus diagnosed
in a 28-year-old primipara at 15 weeks of gestation and discuss the problems associated with the ultrasound diagnosis,
histopathological examination of molar tissue samples and treatment.
Material and methods: A systematic research of the literature was conducted in PubMed database and Cochrane Library,
including case reports and case series. A new case was also discussed. We collected data regarding the patient’s serum
human chorionic gonadotropin (hCG) level, initial symptoms, diagnosis and treatment.
Results: Most of the cases reported in the literature are those of a multiple pregnancy with complete hydatidiform
mole (CHM) and a coexistent live fetus. The coexistence of a twin pregnancy with partial hydatidiform mole (PHM)
and a live fetus in two separate amniotic sacs is extremely rare as a partial mole usually causes miscarriage of early
pregnancy. Ultrasound is an important diagnostic tool, but the correct diagnosis is made only in 68% of cases.
With further histological assessment of molar specimens and biochemical assays, the rates of correct early diagnoses should
increase contributing to early therapeutic decisions and fewer adverse events.
Conclusions: The diagnosis, management, and monitoring of this condition will remain challenging because of its rarity.
Because of that, all cases of a suspected multiple pregnancy with a hydatidiform mole and a coexistent live fetus should be
referred to and managed at a tertiary center which specializes in the diagnosis and treatment of gestational trophoblastic
disease.

Abstract

Objectives: We report the case of a twin pregnancy with a partial hydatidiform mole and a coexistent live fetus diagnosed
in a 28-year-old primipara at 15 weeks of gestation and discuss the problems associated with the ultrasound diagnosis,
histopathological examination of molar tissue samples and treatment.
Material and methods: A systematic research of the literature was conducted in PubMed database and Cochrane Library,
including case reports and case series. A new case was also discussed. We collected data regarding the patient’s serum
human chorionic gonadotropin (hCG) level, initial symptoms, diagnosis and treatment.
Results: Most of the cases reported in the literature are those of a multiple pregnancy with complete hydatidiform
mole (CHM) and a coexistent live fetus. The coexistence of a twin pregnancy with partial hydatidiform mole (PHM)
and a live fetus in two separate amniotic sacs is extremely rare as a partial mole usually causes miscarriage of early
pregnancy. Ultrasound is an important diagnostic tool, but the correct diagnosis is made only in 68% of cases.
With further histological assessment of molar specimens and biochemical assays, the rates of correct early diagnoses should
increase contributing to early therapeutic decisions and fewer adverse events.
Conclusions: The diagnosis, management, and monitoring of this condition will remain challenging because of its rarity.
Because of that, all cases of a suspected multiple pregnancy with a hydatidiform mole and a coexistent live fetus should be
referred to and managed at a tertiary center which specializes in the diagnosis and treatment of gestational trophoblastic
disease.

Get Citation

Keywords

hydatidiform mole; twin pregnancy; ultrasound; histopathological examination

About this article
Title

Twin pregnancy with a partial hydatidiform mole and a coexistent live fetus. Diagnostic and therapeutic dilemmas. A case report and the review of literature

Journal

Ginekologia Polska

Issue

Vol 91, No 10 (2020)

Article type

Research paper

Pages

589-594

Published online

2020-10-30

DOI

10.5603/GP.a2020.0109

Pubmed

33184826

Bibliographic record

Ginekol Pol 2020;91(10):589-594.

Keywords

hydatidiform mole
twin pregnancy
ultrasound
histopathological examination

Authors

Malgorzata Gajewska
Aleksandra Zygula
Miroslaw Wielgos
Grzegorz Szewczyk

References (19)
  1. Giorgione V, Cavoretto P, Cormio G, et al. Prenatal Diagnosis of Twin Pregnancies with Complete Hydatidiform Mole and Coexistent Normal Fetus: A Series of 13 Cases. Gynecol Obstet Invest. 2017; 82(4): 404–409.
  2. Freis A, Elsässer M, Sohn C, et al. Twin Pregnancy with One Fetus and One Complete Mole - A Case Report. Geburtshilfe Frauenheilkd. 2016; 76(7): 819–822.
  3. Ingec M, Borekci B, Altas S, et al. Twin pregnancy with partial hydatidiform mole and coexistent normal fetus. J Obstet Gynaecol. 2006; 26(4): 379–380.
  4. Peng HH, Huang KG, Chueh HY, et al. Term delivery of a complete hydatidiform mole with a coexisting living fetus followed by successful treatment of maternal metastatic gestational trophoblastic disease. Taiwan J Obstet Gynecol. 2014; 53(3): 397–400.
  5. Gupta K, Venkatesan B, Kumaresan M, et al. Early Detection by Ultrasound of Partial Hydatidiform Mole With a Coexistent Live Fetus. WMJ. 2015; 114(5): 208–11; quiz 212.
  6. Imafuku H, Miyahara Y, Ebina Y, et al. Ultrasound and MRI Findings of Twin Pregnancies with Complete Hydatidiform Mole and Coexisting Normal Fetus: Two Case Reports. Kobe J Med Sci. 2018; 64(1): E1–E5.
  7. Braga A, Obeica B, Werner H, et al. A twin pregnancy with a hydatidiform mole and a coexisting live fetus: prenatal diagnosis, treatment, and follow-up. J Ultrason. 2017; 17(71): 299–305.
  8. Vaisbuch E, Ben-Arie A, Dgani R, et al. Twin pregnancy consisting of a complete hydatidiform mole and co-existent fetus: report of two cases and review of literature. Gynecol Oncol. 2005; 98(1): 19–23.
  9. Gupta M, Vang R, Yemelyanova AV, et al. Diagnostic reproducibility of hydatidiform moles: ancillary techniques (p57 immunohistochemistry and molecular genotyping) improve morphologic diagnosis. Am J Surg Pathol. 2012; 36(3): 443–453.
  10. Sebire NJ, Foskett M, Paradinas FJ, et al. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin. Lancet. 2002; 359(9324): 2165–2166.
  11. Sun Cj, Zhao Yp, Yu S, et al. Twin pregnancy and partial hydatidiform mole following in vitro fertilization and embryos transfer: a novel case of placental mosaicism. Chin Med J (Engl). 2012; 125(24): 4517–4519.
  12. Bristow RE, Shumway JB, Khouzami AN, et al. Complete hydatidiform mole and surviving coexistent twin. Obstet Gynecol Surv. 1996; 51(12): 705–709.
  13. Matsui H, Sekiya S, Hando T, et al. Hydatidiform mole coexistent with a twin live fetus: a national collaborative study in Japan. Hum Reprod. 2000; 15(3): 608–611.
  14. Niemann I, Sunde L, Petersen LK. Evaluation of the risk of persistent trophoblastic disease after twin pregnancy with diploid hydatidiform mole and coexisting normal fetus. Am J Obstet Gynecol. 2007; 197(1): 45.e1–45.e5.
  15. Steller MA, Genest DR, Bernstein MR, et al. Clinical features of multiple conception with partial or complete molar pregnancy and coexisting fetuses. J Reprod Med. 1994; 39(3): 147–154.
  16. Bruchim I, Kidron D, Amiel A, et al. Complete hydatidiform mole and a coexistent viable fetus: report of two cases and review of the literature. Gynecol Oncol. 2000; 77(1): 197–202.
  17. Coyle C, Short D, Jackson L, et al. What is the optimal duration of human chorionic gonadotrophin surveillance following evacuation of a molar pregnancy? A retrospective analysis on over 20,000 consecutive patients. Gynecol Oncol. 2018; 148(2): 254–257.
  18. Whittington J, Fantz CR, Gronowski AM, et al. The analytical specificity of human chorionic gonadotropin assays determined using WHO International Reference Reagents. Clin Chim Acta. 2010; 411(1-2): 81–85.
  19. Lybol C, Sweep FC, Harvey R, et al. Relapse rates after two versus three consolidation courses of methotrexate in the treatment of low-risk gestational trophoblastic neoplasia. Gynecol Oncol. 2012; 125(3): 576–579.

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