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.
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