What are the clinical methods for diagnosing hydatidiform mole? Experts indicate that three primary clinical approaches are commonly used, detailed below.
Three Clinical Methods for Diagnosing Hydatidiform Mole
(1) Ultrasound:
Abnormally enlarged uterus with numerous dense echogenic foci and honeycomb-like hypoechoic areas within the cavity. At low resolution, a coarse-grained or snowflake-like pattern may appear.Complete hydatidiform moles show no fetal or placental images, while partial moles may display both. Some patients exhibit unilateral or bilateral adnexal cysts of varying sizes with multiple chambers.
(2) Abnormally Elevated Serum HCG:
Experts note that in hydatidiform mole cases, serum HCG levels rarely fall below normal pregnancy levels. The ratio of free β-HCG to total HCG is significantly higher than in normal pregnancies.
(3) Chest X-ray
Chest X-rays may reveal pulmonary metastases in hydatidiform mole patients.
(4) Gynecological examination
The uterus is enlarged and soft. When vaginal or cervical metastases occur, localized purplish-blue nodules may be visible.
(5) Other investigations
Brain CT scans may show metastatic lesions, or cerebrospinal fluid HCG levels can be measured to confirm brain metastases.
What are the key diagnostic points for hydatidiform mole?
I. Medical History
(1) Vaginal bleeding after amenorrhea: Irregular vaginal bleeding occurs 6–8 weeks after amenorrhea, ranging from light to heavy, sometimes accompanied by grape-like tissue discharge. Repeated bleeding may lead to anemia and secondary infection without treatment.
(2) Abnormally enlarged, soft uterus and abdominal pain: Over half of patients present with a uterus larger than the gestational age, softened in texture. Tissue discharge may cause lower abdominal pain due to uterine contractions. Torsion of the corpus luteum cyst can present as acute abdomen.(3) Hyperemesis gravidarum and preeclampsia: Some patients experience early-onset, severe, and prolonged hyperemesis gravidarum. Preeclampsia may develop during mid-pregnancy, potentially progressing to eclampsia. (4) Absence of fetal movement, heartbeat, or palpable fetal body at 4–5 months gestation. (5) Rarely, hyperthyroidism or trophoblastic embolism causing heart failure may occur.
II. Physical Findings
In 50% of cases, the uterus is larger than expected for gestational age; in a minority, it may be smaller or equal to gestational age. Ovarian corpus luteum cysts are common, and adnexal masses may sometimes be palpable.