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The association of histopathologic features and postmolar gestational trophoblastic neoplasia among patients with complete hydatidifrom mole

Kathleen Gizelle J. Samonte, MD and Agnes L. Soriano-Estrella, MD, MHPEd, FPOGS, FPSSTD
Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines-Manila

Objective: The study aims to correlate the histopathologic characteristics of patients diagnosed with complete hydatidiform moles with the risk of developing postmolar gestational trophoblastic neoplasia.

Methodology: A retrospective review of 71 histopathologically-confirmed cases of complete hydatidiform moles was made. Group 1 consisted of 65 patients who achieved normal titers and remained to have normal ?-hCG titers after at least 1 year of follow up. Group 2 included 6 patients who developed postmolar gestational trophoblastic neoplasia. Histopathologic slide review was done to assess the following: trophoblastic proliferation, nuclear atypia, hemorrhage, necrosis along with measurement of the shortest diameter of the largesthydropic villus. The association of the histopathologic features and the development of postmolar gestational trophoblastic neoplasia was done using chi square. Analysis of the association of histopathologic features included in the study predictive of the development of postmolar gestational trophoblastic neoplasia was done.

Results: Analysis of several histopathologic parameters which may precisely identify which patients with complete hydatidiform moles were more likely to develop postmolar gestational trophoblastic neoplasia failed to produce statistically significant results. However, among the all the features studied, the presence of extensive necrosis favored the occurrence of postmolar sequela.

Conclusion: Trophoblastic proliferation, nuclear atypia, hemorrhage and villus size of complete hydatidiform moles do not predict progression to postmolar disease. In spite of this, all patients with complete hydatidiform moles should be considered for prophylactic chemotherapy or should be monitored closely.