Hydatidiform - mole, characterized histologically by

(Hydropic degeneration of the villous storma): Ref: 193-97, 201-DHYDATIDIFORM MOLE (Vesicular mole) - It is an abnormal condition of placenta where there are partly degenerative and partly proliferative changes in the young chorionic villi.* It is best regarded as a benign neoplasm of the chorion with malignant potential* Vaginal bleeding is the commonest presentation (90%) "white currant in red currant juice"* Expulsion of grape like vesicles (rich in HCG) per vaginum is diagnostic of vesicular mole* Histology shows - hydropic degeneration of the villous stroma with absence of blood vessels and trophoblastic proliferationRISK FACTORS FOR MALIGNANT CHANGE* Patient above the age of 40 irrespective of parity* Patients having previous 3 or more births irrespective of age. Age is more important than the parity* Initial serum hCG > 100,000 mIU/ml* Uterine size >20 weeks* Previous history of molar pregnancy* Large (> 6 cm) thecaleutin cystsImportant features of complete and Partial molesFEATURESCOMPLETE (CLASSIC) MOLEINCOMPLETE* Embryo/fetusAbsentPresent* Hydropic degeneration of villiPronounced and diffusedVariable and focal* Trophoblast hyperplasia * Uterine sizeDiffuseFocal* Theca leutin cystsMore than the date (30 - 60%)Less than the date* KaryotypeCommon (25 - 50%)Uncommon* phCG46 XX (85%) Paternal in originTriploid (90%) diploid (10%)* Classic clinical symptomsHigh (> 50, 000)CommonSlight elevation (< 50,000)Rare* Risk of persistent gestational trophoblastic neoplasia (GTN)20%<5%