Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
Abstract
A 29-year-old primigravida, 22 weeks of gestation, complained of
abdominal lump, pain in the abdomen, episodes of vasovagal attacks,
headache and intermittent episodes of spotting. On physical examination
she was normotensive and fundal height was 20 cm. Two big firm masses
were palpable in the lumbar regions bilaterally. The foetal heartbeats
were ausculated normally. Antenatal ultrasound examination revealed a
live foetus, which had measurements consistent with 22 weeks of
gestation. The placenta was anterior in location and showed grade I
maturity, without any focal lesion. Another markedly enlarged mass,
separate from the anterior normal placenta, with small cystic areas and
increased echogenicity was seen along the posterior uterine wall,
typically showing "snow storm" appearance. These changes were
consistent with hydatidiform molar changes most probably in the second
placenta (Figure 1). Two large extrauterine, predominantly cystic
masses were also seen in the lumbar regions bilaterally near the fundus
of the uterus. They were showing multiple cystic areas within it and
measured approximately 15 X 15 cm in size. These were suggestive of
theca lutein cysts in both enlarged ovaries in association with the
hydatidiform mole (Figure 2). Serum titre of beta-HCG at 22 weeks was
1,20,000 mIU/ml. Chest x-ray, thyroid and liver function tests were
normal. Repeat ultrasound at 24 weeks revealed exacerbation of
placentomegaly and onset of polyhydramnios. The symptoms continued to
increase and the patient underwent spontaneous delivery at 28 weeks of
gestation and delivered a baby with weight of 1450 grams. The normal
placenta was delivered within 15 minutes after birth and the abnormal
posterior placenta was removed subsequently using surgical approach.
The histopathology of the abnormal posterior placenta revealed
hydatidiform (grapelike, cystic) degeneration of chorionic villi with
inadequate vascularisation and abnormal, excessive proliferation of
placental trophoblasts. Karyotype of the baby's white cells and mole
revealed normal 46-XX chromosomal patterns. Mother's chest radiograph,
abdomino-pelvic sonography and serum CA-125 marker study done post
partum did not reveal any abnormality. She was not give any
chemotherapy