Answer for BIR CoW 04 May 2025
Molar Pregnancy
Findings
Ultrasound (USG):
Discussion
Molar Pregnancy (Hydatidiform Mole):
A form of gestational trophoblastic disease (GTD), molar pregnancy represents abnormal trophoblastic proliferation and villous edema.
Classification of GTD:
Treatment
Medical Management:
Findings
Ultrasound (USG):
- Uterus is enlarged and filled with a heteroechoic, predominantly anechoic mass composed of numerous tiny cystic structures, producing a characteristic "snowstorm appearance."
- Increased vascularity is noted in the myometrium.
- A large heterogeneous mass measuring 9.4 × 14 × 17.2 cm is seen filling and distending the endometrial cavity.
- The lesion demonstrates T1 hypointense foci and T2 heterogeneous hyperintensity.
- No fetal pole is visualized.
- Diffuse thinning of the myometrium, with suspicious myometrial invasion noted at the right lateral aspect near the fundus.
- Multiple flow voids are observed in the posterior myometrium, suggestive of high vascularity.
- No definitive extrauterine extension is seen.
- Mild free fluid in the pelvis.
- Bilateral ovaries could not be visualized.
- Large heterogeneous mass occupying and distending the endometrial cavity with no identifiable fetal pole.
- Imaging features consistent with Molar Pregnancy, with suspicious myometrial invasion on the right near the fundus.
Discussion
Molar Pregnancy (Hydatidiform Mole):
A form of gestational trophoblastic disease (GTD), molar pregnancy represents abnormal trophoblastic proliferation and villous edema.
Classification of GTD:
- Hydatidiform Mole (Benign but premalignant)
- Complete Mole
- Partial Mole
- Gestational Trophoblastic Neoplasia (Malignant)
- Invasive Mole
- Choriocarcinoma
- Placental Site Trophoblastic Tumor (PSTT)
- Epithelioid Trophoblastic Tumor (ETT)
Treatment
Medical Management:
- Chemotherapy (particularly for invasive or persistent disease).
- Hormonal therapy in select cases.
- Suction and evacuation – primary treatment for molar pregnancy.
- Hysterectomy – considered in older patients or those with recurrent molar pregnancy or when fertility preservation is not a concern.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!