Complete Hydatidiform Mole with Lung Metastasis and Coexisting Live Fetus: Unexpected Twin Pregnancy Mimicking Placenta Accreta

Abstract

Twin pregnancy with a complete hydatidiform mole and coexisting fetus (CHMCF) is an exceedingly rare condition with an incidence of about 1 in 20,000-100,000 pregnancies. It can be detected by prenatal ultrasonography and an elevated maternal serum beta-human chorionic gonadotropin (BhCG) level. Herein, the author reports a case of CHMCF which was incidentally diagnosed through pathologic examination without preoperative knowledge. The 41-year-old woman, transferred due to preterm labor, delivered a female baby by cesarean section at 28 + 5 weeks of gestation. Clinically, the surgeon suspected placenta accreta on the surgical field, and the placental specimen was sent to the pathology department. On gross examination, focal vesicular and cystic lesions were identified separately from the normal-looking placental tissue. The pathologic diagnosis was CHMCF and considering the fact that placenta accreta was originally suspected, invasive hydatidiform mole was not ruled out. After radiologic work-up, metastatic lung lesions were detected, and methotrexate was administered in six cycles at intervals of every two weeks. The author presents the clinicopathological features of this unexpected CHMCF case accompanied by pulmonary metastasis, compares to literature review findings, and emphasizes the meticulous pathologic examination.

Keywords: complete hydatidiform mole; gestational trophoblastic disease; twin pregnancy.

Figure 1

Ultrasonographic findings after admission. (A) Placenta with hypervascularity and high blood flow in subplacental area (yellow arrow); (B) Blood clot in cervical canal (asterisk).

Figure 2

Gross and microscopic findings of CHMCF. (A) Separately identified small vesicles on gross examination (yellow arrow); (B) Two groups of villi: hydropic villi with cistern formation and relatively small normal-looking villi (12.5×); (C) Complete hydatidiform mole area with massive necrosis (asterisk) (12.5×); (D) Negative p57 immunohistochemical staining of complete hydatidiform mole (12.5×); (E) Positive p57 immunohistochemical staining of normal area (100×); (F) Chorangioma (40×).

Figure 3

Chest computed tomography (CT) highlighting multiple pulmonary metastasis (yellow arrows). (A) Metastatic lesion in right middle lobe on coronal view; (B) Metastatic lesion in left upper lobe on axial view; (C) Metastatic lesions in both lobes on coronal view.