INVASIVE MOLE AFTER NORMAL PREGNANCY,report of a rare case and literature review

Background and Aim : Gestational trophoblastic neoplasia (GTN) refers to a group of malignantneoplasms that consist of abnormal proliferation of trophoblastic tissue, and may follow a hydatidiformmole or a nonmolar pregnancy. GTN is comprised of the following histologic types:Invasivemole,Choriocarcinoma,Placental site trophoblastic tumor (PSTT),Epithelioid trophoblastic tumor (ETT).Invasive mole develops after a molar pregnancy and is characterized by the presence of edematouschorionic villi with trophoblastic proliferation invading the myometrium.We report a case of invasive moleafter normal term delivery.Methods : Invasive mole is a condition where a molar pregnancy, such as a partial hydatidiform mole orcomplete hydatidiform mole, invades the wall of the uterus, potentially spreading and metastasizing to otherparts of the body (such as the vagina or lung ) Invasive moles occur in about 20% of molar pregnancies butare more common in complete molar pregnancies than in partial molar pregnancies. Invasive moles candevelop both before and after treatment by D & C.Treatment of an invasive mole may includechemotherapy. We report a 35 yrs old G2P2 woman who refered to emergency ward of Arash womenhospital with massive uterine bleeding.she had a normal term delivery 50 days ago and had not anyabnormal bleeding after her normal vaginal delivery.She had not any abnormal finding in prenatal care andserial prenatal sonographies were normal in all trimesters of pregnancy.After admitting and stabling thepatint,the sonography and MRI of the pelvic reveales AVM malformation in posterior wall of the uterus.thepatient trended to do hysterectomy and refuse any other therapy including receiving Actinomycin or uterineartery ambolization.after hysterectomy ,report of pathology reveales invasive mole in the myometrium.Sherefused receving chemotherapy so she was followed and bhcg dropped well and she curedResults : invasive mole is penetration of molar tissue (complete or partial mole) into myometrium or uterinevasculature .Edema- tous villus and proliferative trophoblasts invade myometrium so they can bedistinguished from choriocarcinoma. Pathologists mention the existence of villi in trophoblastic tissueLocally invasive gestational trophoblastic neoplasia develops in 15% of patients and metastatic form in 4%of patients after evacuation of complete mole and infrequently after partial mole.GTN may presented onlywith AUB.Occurence of invasive mole after normal pregnany is very rare Conclusion : Althouth uncommon invasive mole can happen after nonmolar pregnancy.In women withmassive utrine bleeding and AVM malformation we must proposed GTN.

Keywords:

GTN , INVASIVE MOLE , NORMAL PREGNANCY