Findings: The uterus is enlarged and the endometrial cavity is filled with an echogenic structure. This lesion contains multiple small cysts. Low-resistive flow is recorded on spectral and color doppler.
Diagnosis: Hydatidiform mole.
Discussion: Hydatidiform mole may present in the 1st or 2nd trimester of pregnancy w/vaginal bleeding, abdominal pain, hyperemesis and hypertension. Ultrasound is useful for the diagnosis of many types of gestational trophoblastic disease.
During the first trimester, the uterus may appear enlarged and filled with a hyperechoic mass with many cystic structures. The cysts measure 1 - 2 mm. and may not be seen sonographically. During the 2nd trimester, the cysts enlarge to approximately 2 cm. in diameter; this allows a more accurate diagnosis to be made by ultrasound. Thrombus and spontaneous abortion must be considered in the differential diagnosis.
A "partial" mole is defined by visualization of an embryo, a gestational sac or localized disease. Diffuse involvement of the endometrial cavity, without the presence of an embryo, are findings consistent with a complete mole. Malignant degeneration occurs more commonly with complete molar pregnancy. An invasive mole is suspected when a well-circumscribed echogenic lesion is present within the uterine myometrium on ultrasound exam, following surgical removal of a molar pregnancy. This entity is distinguished from choriocarcinoma which occurs after a normal pregnancy, an ectopic pregnancy or spontaneous abortion.
DNA studies reveal that the majority of hydatidiform moles to contain chromosomes of paternal origin.
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