Molar Pregnancy / Pelvic and Reproductive organs

Figure 1. Sagital T2-weighted MRI image of partial hydatidiform molar pregnancy.








 
Figure 2. Coronal T2-weighted MRI image of partial hydatidiform molar pregnancy 









A Molar pregnancy is an abnormality of the placenta, caused by a problem when the egg and sperm join together at fertilization. After a sperm fertilizes an egg, new tissues develop that normally form the fetus and placenta.  In a molar pregnancy the tissues that were suppose to form the placenta grow abnormally and can form a tumor that can spread beyond the womb or uterus.  The formal medical term for a molar pregnancy is "hydatidiform mole" and is also known as gestational trophoblastic disease.  There are two types of molar pregnancy: a complete mole where no normal fetal tissue forms, and a partial mole where incomplete fetal tissues develop alongside molar tissue.  Both forms are due to problems during fertilization.  A more aggressive tumor associated with molar pregnancies is an invasive mole.  The invasive mole contains many villi, but these may grow into or through the muscle layer of the uterus wall.  Sometimes, invasive moles can cause bleeding by perforating the uterus through its whole thickness.  This invasive mole can develop into a choriocarcinoma, a fast growing cancerous form of gestational trophoblastic disease. Potential causes may include defects in the egg, problems within the uterus, or a diet low in protein, animal fat, and vitamin A. For the most part it is idiopathic and not very easy to determine the cause. A women is also more likely to have a molar pregnancy if they have had one in the past.

My 30 yr old daughter has been diagnosed with molar pregnancies twice over the last 5 years.  Both of the moles were invasive and turned into choriocarcinomas.  She underwent chemo shots the first time and chemo infusions the second.  So far she has been cancer free since 12/2007, but may never be able to have children.  They have no clue what the cause is, they are thinking it might be her eggs, but really have no way of knowing.
 
Symptoms include abdominal swelling caused by the uterus becoming larger, excessive vomiting, fatigue, pelvic cramping with vaginal discharge, heavy bleeding, and in rare cases SOB with coughing and blood because choriocarcinoma can spread to the lungs before a molar pregnancy is diagnosed.

If a women is diagnosed with a molar pregnancy, further testing will be done to determine the type of mole and the possability of it having spread outside the uterus.  Testing may include chest x-rays, CT scans, MRI scans, and mostly ultrasound imaging.

Treatment may include a suction curettage (D and C) may be performed.  A hysterectomy, (removal of the uterus) may be an option for older women who do not wish to have future pregnancies.  Also chemotherapy with a single drug or multiple drugs, as well as radiation therapy.  With the appropriate treatment, all hydatidiform moles are curable, and nearly all cases of more aggressive invasive tumors can be cured with combination of surgery or chemotherapy.  It is important for women with molar pregnancies to be evaluated periodically after the mole has been treated.  Women are also advised not to attempt pregnancy for some time in order to be sure that levels of HCG remain at zero and that no further treatment is needed.  HCG levels should be checked periodically as an ongoing basis for follow up.

Wilms Tumor / Abodomen

              

                                                          
Magnetic resonance imaging (MRI) of Wilms Tumor on right kidney.

CT Scan of 11 cm Wilms' tumor of right kidney in 13 month old patient
 
   
 Wilm's tumor is a canerous tumor of the kidney that usually occurs in young children.  It is the fifth most common pediatric malignancy and the most common type of renal tumor in children. 

When and unborn baby is developing, the kidneys are formed from primitive cells.  Overtime these cells become more specialized.  The cells mature and organize into the normal kidney structure.  Sometimes clumps of these cells remain in their original primitive form.  If theses cells begin to multiply after birth, they may form a large mass of abnormal cells.  This formation is known as a Wilm's tumor or also called Nephroblastoma.  Wilm's tumor is a type of malignant tumor.  Which means it is made up of abnormal and immature cells.  These cells are also capable of invading other nearby structures within the kidney and can also travel out of the kidney into other structures.  Malignant cells can even travel through the body to invade other organ systems, most commonly the lungs and brain.

A Wilm's tumor occurs in about 1 out of 200,000 to 250,000 children.  It usually is diagnosed when a child is about 3 years old.  It rarely develops after age 8.  Symptoms include an abdominal mass, abdominal pain, fever, constipation, high blood pressure, increased growth on only one side of the body, loss of appetitie, nausea, vomiting, and abnormal urine color may also be associated with this disease.

Tests and diagnosis include: abnormal ultrasound, abdominal x-ray, CT scan of the abdomen, BUN, complete blood count, urinalysis, intravenous pyelogram, and MRI and other tests may be utilized to determine if the tumor has spread. The first step in treatment is to stage the tumor.  Staging helps the doctors determine how far the cancer has spread and to plan for the best treatment.  Surgery to remove the tumor is scheduled as soon as possible.  Radiation therapy and chemotherapy may be needed after surgery, depending on the stage of the tumor.  Follow up tests will be needed for future evaluation, however children whose tumor has not spread have a 90% cure rate with appropriate treatment.