11/27. First trimester diagnosis of partial mole.BACKGROUND: Partial mole is one of the two distinctive subtypes of hydatidiform mole. It is usually paternally derived triploid conceptions in which embryonal development occurs in association with trophoblastic hyperplasia. The definite diagnosis is confirmed by pathological and cytogenetic studies. Ultrasound might be helpful to diagnose partial mole in the first trimester. CASE: A 25-year-old woman, gravida 2, para 0-0-1-0, was initially seen for antenatal care at 6 weeks' pregnant. Ultrasound was undertaken at 13 weeks' pregnancy due to her first fetal anomaly, which demonstrated partial mole and embryonic death. The serum beta hCG was 190,900 mIU/ml. suction curettage was performed without complication. Histopathological study confirmed partial mole and cytogenetic study of the placenta revealed an uncommon karyotype, mosaicism of triploid (69,XXX/69,XXY). serum beta hCG was declined and negative at 8 weeks. The patient was well and serum beta hCG remained normal throughout 6 months of follow-up. CONCLUSION: Although the majority of partial mole pregnancies cannot be detected by routine first trimester ultrasound examination, first trimester ultrasound can be helpful in some cases, such as this one. If partial mole is sonographically suspected, it should be confirmed with histopathology and cytogenetic studies. The management is similar to complete mole including prompt evacuation and careful monitoring of beta hCG.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
12/27. Magnetic resonance experience of a twin pregnancy with a normal fetus and hydatidiform mole: a case report.A case of twin pregnancy with a coexistent hydatidiform mole after in vitro fertilization is presented. Prenatal magnetic resonance (MR) imaging at 20 gestational weeks demonstrated a normal fetus and a distinct junction between the molar tissue and myometrium suggesting no evidence of myometrial invasion. Clinically, the rare disease entity involves a high risk of maternal complications and intrauterine fetal death. The application of ultrafast MR imaging for prenatal examination provides important additional information for prenatal counseling and obstetric management.- - - - - - - - - - ranking = 7.5554186962983keywords = fertilization (Clic here for more details about this article) |
13/27. Complete hydatidiform mole and normal live birth following intracytoplasmic sperm injection.A twin pregnancy with complete hydatidiform mole (HM) and preterm birth of a normal female infant after intracytoplasmic sperm injection (ICSI) conception was experienced. ICSI due to severe oligozoospermia was performed on three ova, and three embryos with confirmed two proneclei (2PN) were subsequently transferred to the uterus. At 7 weeks of gestation, molar pregnancy as well as a viable fetus was recognized. At 33 weeks, the pregnancy was terminated due to preterm labor. Dichorionic pregnancy consisting of a normal fetus and placenta in one chorionic membrane and complete HM in the other was recognized. Cytomolecular analysis indicated that the complete HM genome was derived from duplication of a single sperm, and a normal neonate was from biparental genomes. It should be noted that ICSI can avoid incomplete HM (mostly triploid) due to multi-sperm fertilization but might not be able to avoid complete HM (paternal diploid) although such a risk is very low. This is the second report of this condition and is accompanied by the first well-described molecular analysis.- - - - - - - - - - ranking = 8.5554186962983keywords = fertilization, conception (Clic here for more details about this article) |
14/27. Persistent gestational trophoblastic disease after an androgenetic/biparental fetal chimera: a case report and review.We present a case of a dichorionic/diamniotic twin pregnancy in which one twin presented with ultrasound findings suggestive of molar changes in the placenta. The placenta of twin A seemed to be grossly enlarged and cystic, and twin A was small for gestation. After an inevitable abortion, a detailed histological and genetic evaluation was performed on the fetus and placenta from twin A, including traditional cytogenetic techniques, microsatellite marker analysis, fluorescent in situ hybridization, and p57 immunostaining. It was determined that twin A was a chimera with a biparental XX cell line and an androgenetic XY cell line. The 2 cell lines were present in both the placenta and the fetus. The patient later developed and was treated for persistent gestational trophoblastic disease, which has been shown to have an increased risk after an androgenetic conception. Cases of mosaicism or chimerism involving an androgenetic cell line may be difficult to diagnose histologically but are critical to identify because of the increased risk for persistent gestational trophoblastic disease. Therefore, we emphasize the importance of using multiple molecular, cytogenetic, and immunohistochemical techniques when diagnosing cases involving such unusual placental abnormalities. To our knowledge, this is the first reported case of persistent gestational disease after a fetal chimera.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
15/27. hydatidiform mole and fetus with normal karyotype: support of a separate entity.Repetitive hydatidiform mole was observed in four pregnancies. The pregnancies presented with heavy bleeding and vomiting, but the post-evacuation courses were uncomplicated, with rapid regression of serum hCG levels. Cytogenetic investigations, analyses of restriction fragment length polymorphisms, and flow cytometry in three pregnancies were consistent with diploid, biparental conception as the origin of fetal tissue and molar and nonmolar villi. In one pregnancy, the analyses of cytogenetic markers suggested the coexistence of two different cell lines of dizygotic, biparental origin, whereas dna analysis was consistent with a single conception. With incomplete genetic information, a hydatidiform mole with coexistent normal fetus is generally considered to result from dizygous twinning comprising an androgenetic complete mole and a normal conception. In the present gestations, the results based on several techniques applied on numerous samples from different tissues render this possibility unlikely. Some of the contradictions between histologic and cytogenetic classifications of hydatidiform mole may be explained by diploid, biparental partial mole, which seems to constitute a separate subgroup within hydatidiform mole. Following chorionic villus sampling or amniocentesis, continued pregnancy may be considered, depending on prenatal diagnosis including genetic marker analysis.- - - - - - - - - - ranking = 3keywords = conception (Clic here for more details about this article) |
16/27. hydatidiform mole after in-vitro fertilization: a case report.A 25 year old patient was accepted on the in-vitro fertilization programme at Groote Schuur Hospital in Cape Town and her first IVF cycle resulted in a pregnancy. The patient did not return to the usual follow-up ultrasound until about 4 months after the embryo transfer when an ultrasound revealed the typical picture of a molar pregnancy which was confirmed by histology after evacuation.- - - - - - - - - - ranking = 37.777093481491keywords = fertilization (Clic here for more details about this article) |
17/27. hydatidiform mole: cytogenetic marker analysis in twin gestation. Report of two cases.A hydatidiform mole associated with a fetus proved to be the result of twin gestation. On microscopic examination of the placenta the case was classified as a partial hydatidiform mole. Chromosomal markers were, however, consistent with a normal conception and a mole of diploid androgenetic origin. Chromosome analysis of a morphologic complete molar specimen yielded two cell lines, one consistent with a normal conception and one with diploid androgenesis. Twinning in molar specimens must therefore be considered, regardless of macroscopic appearance. The prenatal diagnosis of a coexisting fetus and molar placenta poses a real clinical problem; analyses must distinguish between a partial mole plus a triploid fetus and a normal fetus occurring with a partial or a complete mole. The distinction is important for decisions made during pregnancy and may be of prognostic significance after termination. The usefulness of chromosome marker analysis in distinguishing between the various origins is pointed out, and it is suggested that twin pregnancy with hydatidiform mole is more frequent than its description in the literature would suggest.- - - - - - - - - - ranking = 2keywords = conception (Clic here for more details about this article) |
18/27. Dispermy as the origin of partial moles as well as a nonmolar conception.All 3 triploid conceptuses examined had a common, dispermic origin. When histological diagnoses were reconsidered in this light 1 conceptus turned out to be nonmolar. This supports recent case reports which indicate that dispermic triploids may be either molar or nonmolar.- - - - - - - - - - ranking = 4keywords = conception (Clic here for more details about this article) |
19/27. hydatidiform mole with a surviving coexistent fetus following in-vitro fertilization.A case of a hydatidiform mole with a surviving coexistent fetus following in-vitro fertilization and embryo transfer is reported. The diagnosis was established at 12 weeks gestation and pregnancy was maintained until 31 weeks, during which time transient hyperthyroidism and lung metastasis developed. No difference was observed in pronucleus formation and early embryonic development between the two embryos, which resulted in a complete mole and a normal fetus. dna finger-print analysis, karyotype analysis and histopathological examination confirmed that the pregnancy was a twin of a complete mole and a normal conception. dna fingerprint analysis was performed with a single-locus probe cocktail. All dna bands from the tumour were of paternal origin, and the bands from the placenta were of paternal and maternal origin.- - - - - - - - - - ranking = 38.777093481491keywords = fertilization, conception (Clic here for more details about this article) |
20/27. Clinical features of multiple conception with partial or complete molar pregnancy and coexisting fetuses.The estimated incidence of twin pregnancy consisting of hydatidiform mole and a coexisting fetus is 1 per 22,000-100,000 pregnancies. Since 1965, nine patients with this entity have been treated at the new england Trophoblastic Disease Center (NETDC), boston. One patient had a partial hydatidiform mole coexisting with a normal placenta and fetus. The other eight patients had twin pregnancies with a complete hydatidiform mole (CHM) and coexisting fetus. We compared the clinical outcomes in these 8 patients and 14 additional published case reports of multiple gestations composed of CHM and coexisting fetuses with a group of 71 patients with singleton CHM treated at NETDC. Twelve of the 22 patients (55%) with CHM and coexisting fetuses developed persistent gestational trophoblastic tumor, requiring chemotherapy. Five of these patients developed metastases requiring multiple cycles of chemotherapy to achieve remission. The presenting symptoms of multiple conception with CHM and coexisting fetuses were similar to those in patients with a singleton conception and complete mole. However, as compared to singleton CHM, patients having a multiple conception with CHM and coexisting fetuses were diagnosed at a later gestational age, had higher preevacuation beta-human chorionic gonadotropin levels and had a greater propensity to develop persistent tumor. These data indicate that patients with multiple conceptions consisting of CHM and coexisting fetuses are at high risk of developing persistent gestational trophoblastic tumor.- - - - - - - - - - ranking = 8keywords = conception (Clic here for more details about this article) |
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