Complete mole & Partial mole -What is difference * malignant potentiality

Complete moles have higher serum levels of free a hCG where as partial moles have higher levels of B-hCG .In complete hydatidiform mole are entirely paternally derived . Monospermic Homozygous . Dispermic Diploidy Heterozygous .Heterozygous moles are more prone to develop invasive mole and c horiocarcinoma. Partial Hydatidiform Mole .The embryo usually survives to an average age of 9 weeks. Since the incidence of triploidy is 1 to 2% in clinical abortions.

Placental site Trophoblastic Tumor (PSTT)

Placental site trophoblastic tumor produces more of hPL than hCG as it contains less syncytitrophoblast and hence hCG may not serve as a reliable tumor marker for follow up .

An ultrasound examination after one week of suction curettage will ensure completeness of evacuation. A repeat (check) curettage is done if the pre-evacuation size of the uterus was >16 weeks and it there is evidence of incomplete evacuation on ultrasonography after one week.

Patients who are RH negative should receive RH immune globulin at the time of evacuation as the Rh D factor is expressed on trophoblast. DPC Immulite series of tests

Fall in serum B –hCG per week follows a long linear fashion.

Serum B-hCG                                                                                     2 weekly till negative for                                                                                                                               four weeks

Serum B-hCG                                                                                     Monthly until one year

                                                                                                                                Post evacuation

Urine sample for hCG                                                    once in 3 months until 2                                                                                                                                years post evacuation

hCG follow up may range from 6 months to 2 years after evacuation.

If the hCG values become negative within 8 weeks after evacuation follow up will be limited to 6 months post evacuation.

Patients who do not have normal hCG 8 weeks post evacuation should have 2 years follow up.

Criteria for diagnosis of POST MOLAR GTN

Serum B hCG                                                     >20000 IU/L 4 weeks

                                                                                After evacuation

Plateau of hCG                  4 measurements over a  

                                                                                Period of 3 weeks

Rise of hCG                                         3 weekly measurements over                                                                                    a period of 2 weeks

Level of hCG                                      Remains elevated 6 months

                                                                                Months past mole.

Criteria for the diagnosis of post hydatidiform mole trophoblastic neoplasia (GTN)

GTN may be diagnosed when the plasteau of human chorionic gonadotropin (hCG) lasts for 4 measurements over a period of 3 weeks or longer that is days 1,7,14,21.

GTN may diagnosed when there is a rise of hCG on three consecutive weekly measurements over a period of two weeks or longer days 1,7,14.

GTN is diagnosed if there is histologic diagnosis of choriocarcinoma

GTN is diagnosed when the hCG level remains elevated for 6 months or more.

DPC Immulite assay and Roche Elecsys hCG assays are reported not to have false positive result