SOUTHERN PHILIPPINES MEDICAL CENTER

INTERHOSPITAL CASE PRESENTATION

PRESENTERS:
OBENZA, AYEZA SHEEN M.
MICAYABAS, LOWIE T.
SANTOS, NICA-ANN G.
TAGSA, MAUREEN JADE P.
 GENERAL DATA

1
• DB
• 25 y/o
• G3 P2 (2002)
• 17 6/7 weeks AOG
• Filipino
• Agdao District, DC
CHIEF COMPLAINT
PAST MEDICAL HISTORY
FAMILY HISTORY

• (+) Hx of Nontoxic Goiter: Paternal

• (-) Other heredofamilial diseases
PERSONAL/ SOCIAL
HISTORY
OBSTETRICS AND
GYNECOLOGIC HISTORY

• GRAVIDA 3 PARA 2
• LMP: 03/09/19
• PMP: 02/20/19
• AOG: 17 6/7 wks
2 REVIEW OF SYSTEMS
3 PHYSICAL EXAMINATION
4 SALIENT FEATURES
 SALIENT FEATURES

PERTINENT POSITIVES PERTINENT NEGATIVES

• 25 years old, Filipino
• Pregnancy test: Positive
• G3 P2 (2002)
• 17 6/7 weeks AOG by LMP
• Vaginal spotting
• Vomiting
• Weight loss
• Abdomen globular, FH: 20 cm
• Internal Examination: Cervix closed.
Corpus enlarged at 20 weeks size
(large for date)
• No headache, dizziness, blurring of
vision
• No palpitations, heat intolerance
• No abdominal pain or cramping
• No fetal heart tone detected
• No adnexal mass or tenderness noted
upon palpation
• No active bleeding per os upon
speculum exam
5 ADMITTING IMPRESSION
 GRAVIDA 3 PARA 2 (2002);
HYDATIDIFORM MOLE 17 6/7
WEEKS AGE OF GESTATION
6 DIFFERENTIAL DIAGNOSES
 MISSED ABORTION

RULE IN RULE OUT

• 25 years old • No abdominal pain or cramping
• 17 6/7 weeks AOG • No passage of meaty tissue or
• Vaginal spotting clots at the cervical canal
• Cervix closed upon bimanual • No active bleeding per os upon
examination speculum exam
• Absence of fetal heart tone by • Corpus enlarged at 20 weeks
doppler size (large for date)
 ECTOPIC PREGNANCY

RULE IN RULE OUT

• No abdominal pain or cramping
• No prior ectopic pregnancy
• 25 years old • No previous surgical operation
• 17 6/7 weeks AOG • No history of prior tubal infection or
• Vaginal spotting STD
• Amenorrhea • Nonsmoker
• Vomiting • Corpus enlarged at 20 weeks size
• Absence of fetal heart tone by doppler (large for date)
• Internal Examination revealing
absence of cervical motion tenderness
7 COURSE IN THE WARD
 TRANSVAGINAL
SONOGRAPHY

Figure 2. Prototype of the characteristic complete hydatidiform mole

ultrasonographic image revealing vesicular
pattern of multiple echoes,
holes within placental
mass and no fetus giving a "snow storm" or "bunch of grapes" type
appearance.
Figure 1. Transvaginal sonography of the patient revealing the “snowstorm Copyright: 2002-2019, PathologyOutlines.com, Inc.
pattern of complete hydatidiform mole”
 INTRAOPERATIVE
FINDINGS

Figure 4. Prototype of a gross image of complete hydatidiform

mole
No fetus develops, but there is an abnormal placenta consisting
of a mass of tissue with grape-like, swollen chorionic villi.
Copyright: 2002-2019, PathologyOutlines.com, Inc.
Figure 3. Gross image of the patient’s post-evacuated diffusely hydropic
placenta. No fetal products are appreciated
 HISTOPATHOLOGIC
REPORT

TROPHOBLASTS

TROPHOBLASTS EDEMATOUS VILLI

EDEMATOUS VILLI

RED BLOOD CELLS

RED BLOOD CELLS

Figure 6: H&E stained, LPO view of diffusely hydropic

chorionic villi with circumferential trophoblastic proliferation.
No trophoblastic inclusions
Figure 5: H&E stained, LPO view of enlarged hydropic villi with
central cisterns (*)
 HISTOPATHOLOGIC
REPORT

DECIDUAL CELLS

CHORIONIC VILLI

Figure 8: H&E stained, HPO view of normal placenta

(prototype)
Copyright: 2002-2019, PathologyOutlines.com, Inc.
Figure 7: H&E stained, HPO view of diffusely hydropic chorionic villi.
Fused trophoblastic cells are seen with atypia (*)
8 FINAL DIAGNOSIS
 GRAVIDA 3 PARA 2 (2002); HYDATIDIFORM
MOLE, COMPLETE; 17 6/7 WEEKS AOG; ANEMIA
MODERATE SECONDARY TO ACUTE BLOOD
LOSS- CORRECTED; STATUS POST SUCTION
AND SHARP CURETTAGE; STATUS POST BLOOD
TRANSFUSION X 2 UNITS; STATUS POST
METHOTREXATE X 1 CYCLE
9 CASE DISCUSSION AND
MANAGEMENT
 ALGORITHM FOR THE DIAGNOSIS AND MANAGEMENT OF HYDATIDIFORM MOLE
our

CLINICAL HISTORY AND

PELVIC ULTRASOUND SERUM BETA HCG TITER
PHYSICAL EXAMINATION

HYDATIDIFORM
COMPLETED FAMILY SIZE MOLE

TOTAL HYSTERECTOMY +/- SUCTION CURETTAGE

BSO
NO RISK FACTOR
WITH RISK FACTOR
POST-EVACUATION hCG
CHEMOPROPHYLAXIS MONITORING
(UNDER THE SUPERVISION OF A TROPHOBLASTIC DISEASE
SPECIALIST)

GESTATIONAL
TROPHOBLASTIC NEOPLASIA

SPONTANEOUS
RESOLUTION REFER TO A TROPHOBLASTIC
25 DISEASES SPECIALIST
SOURCE: CPG FOR THE DIAGNOSIS AND MANAGEMENT OF GESTATIONAL TROPHOBLASTIC DISEASES
MAIN REFERENCES:

White Gray Black

ADDITIONAL REFERENCES:
CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND
MANAGEMENT OF GESTATIONAL TROPHOBLASTIC DISEASES
THANK YOU FOR YOUR KIND ATTENTION.