Cystic mole – is a pathology of pregnancy associated with trophoblast hyperplasia and degeneration of chorionic villi. These latter structures are prone to swelling and turn into bubbles filled with liquid. The condition causes premature termination of pregnancy.
What is trophoblast? This is the initial embryonic development structure that surrounds the blastocytes (future embryo). Starting from about the eighth day of fertilization, this cell complex plays a nutritional role for the embryo and is involved in the formation of the placenta.
Cystic mole is also called molar pregnancy. The Latin term «mole» means «mass». This mass of chorionic villi, resembling clusters of grapes, makes up the fetal part of the placenta. The villi are no longer able to provide the exchange process between the mother and the fetus, and they retain both infiltrative and endocrine properties.
Causes and risk factors
The exact causes of the occurrence of cystic mole are not yet fully understood. However, it is known that molar pregnancy is caused by pathological proliferation of trophoblast, due to the over-expression of individual paternal genes.
Trophoblast hyperplasia can be complete and partial. Full - when the process affects all the villi of the chorion, partial - when the tissue is grown by focus.
Cystic mole is more common before the age of 17 years or after 35 years. The incidence of cystic drift is very high in Asian countries. In Europe, this disease is much less common.
In approximately 40% of cases, molar pregnancy is asymptomatic.
Initially, cystic mole causes symptoms similar to pregnancy symptoms, with the difference that an increase in the size of the uterus occurs too quickly. Also, a woman usually has:
- severe nausea;
- severe vomiting;
- dark red discharge due to separation of the villous chorion;
- pain and sensation of pelvic edema.
Sometimes fragments of tissue similar to grapes can come out of the vagina.
Molar pregnancy can cause serious complications, such as uterine infection, sepsis, collapse.
In approximately 80% of cases, the disease is benign. In 15-20% - penetration into the surrounding tissue occurs and there is a tendency to persist, so called invasive cystic mole. About 2-3% of molar pregnancies evolve into choriocarcinoma, a malignant tumor that metastasizes very quickly through the bloodstream and lymph vessels.
Usually, a pathology is detected when a pregnancy is terminated in the first trimester, in the presence of hemorrhages and pain in the pelvic area. In the second trimester– thanks to ultrasound monitoring. A pregnancy test is positive, but neither a heartbeat nor fetal movements were detected, the uterus is more than normal. Diagnostic confirmation is given by a biopsy with a histological examination of the product of conception and the material obtained by curettage of the uterus. A differential diagnosis should be made with trophoblastic tumors and prolonged retention of miscarriage.
Bubble drift is an indication for curettage of the uterus. Intervention should be performed as soon as possible due to the risk of complications that increase with gestational age. In some cases, surgical removal of the entire organ is necessary. After the operation, a combination of various anticancer drugs (methotrexate, cyclophosphamide, vincristine) can be prescribed.
Specialists of Bogoliuby MC note that a good prognosis of the disease is possible only with adequate and timely treatment. Many women with Cystic mole, after proper treatment, are able to successfully conceive without risking complications. The role of early diagnosis of the condition is extremely important. Patients who had cystic mole are not recommended to become pregnant within six months or a year.