Twin pregnancy with a partial hydatidiform mole and a coexistent live fetus. Diagnostic and therapeutic dilemmas. A case report and the review of literature
, 1, 1, 2
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.
Keywords: hydatidiform moletwin pregnancyultrasoundhistopathological examination
References
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Bristow RE, Shumway JB, Khouzami AN, et al. Complete hydatidiform mole and surviving coexistent twin. Obstet Gynecol Surv. 1996; 51(12): 705–709.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
