TMSS Medical College Journal

Gestational trophoblastic disease encompasses several entities like complete mole, partial mole, invasive mole, gestation- al trophoblastic carcinoma and trophoblastic carcinoma from implantation site. These entities are different from each other by their origin, morphology, their evolution and their treatment. Invasive mole commonly result from complete hydatidiform mole but may do so from partial hydatidiform mole. It does not often progress to choriocarcinoma. It may metastasize but does exhibit progression to true cancer. 10-15% of complete mole can develop into invasive mole. This is one of the important causative factors of miscarriages. Very rarely (2-4%) partial mole can develop into invasive one presenting with features of incomplete abortion, missed abortion and sometimes as obstetric emergencies like intraperito- neal hemorrhage and torrential vaginal bleeding. So, proper diagnosis and timely intervention can prevent mortality and reduce morbidity of the patients. Here we report a case of invasive molar pregnancy with varied picture.

Molar pregnancy is characterized histologically by abnormalities of chorionic villi consisting of varying degrees of trophoblastic proliferation and oedema of villous stroma. It has been classified into complete and partial mole according to the absence or presence of fetal or embryonic elements. Some of these molar pregnancies fail to regress following primary treatment and result in gestational trophoblastic tumors which can be invasive mole, choriocarcinoma, persistent trophoblastic tumor and placental site trophoblastic tumor.! Complete hydatidiform mole is less likely than a partial mole transforms into malignant disease after treatment. But 2 to 4% of women with partial molar pregnancies may develop complication like invasive mole or choriocarcinoma.>* Here we report such a rare case of invasive molar pregnancy presenting with long standing amenorrhoea in perimenopausal woman and eventually development of excessive nausia, vomiting for 3 months and mild lower abdominal pain for last 1 week.