Chorionadenoma (molar pregnancy)

What is chorionadenoma?

Chorionic adenoma is an abnormal formation of the placenta, which is formed only from a set of three chromosomes of the father, while the chromosomes of the mother are absent. The formation of the embryo does not occur, but the drift (intrauterine growth) provokes symptoms of pregnancy. According to statistics, one in a thousand women with symptoms of pregnancy is diagnosed with chorionadenoma. There are two types of chorionadenoma: complete and incomplete.

• Complete chorionadenoma. In place of the normal placenta and embryo, a mole is formed, which can fill the uterus.
• Incomplete chorionadenoma. The placenta is formed incorrectly and develops into a mole. Any formation of fetal tissue has severe defects.

In rare cases of twin pregnancy, one placenta and fetus develop normally, while the other has abnormalities and is diagnosed as chorionadenoma.

Risk factors for chorionadenoma

Chorionic adenoma causes heavy uterine bleeding and in some cases leads to a cell division abnormality known as a trophoblastic tumor.

• In 15-20% of cases of complete chorionadenoma, after its removal, a trophoblastic tumor develops, which sometimes becomes invasive cancer. Fortunately, it is treatable.
• In 5% of cases, incomplete chirion adenoma develops into a trophoblastic tumor.

Rarely, abnormal tissue metastasizes to other organs of the body.

Causes of chorionadenoma

Chorionic adenoma is thought to be the result of a genetic mutation in the egg or sperm. It develops early in pregnancy when:

• an egg without genetic information is fertilized (loss of maternal genes), the sperm chromosomes are duplicated, and a mole is formed (uniparental disomy);
• one healthy egg is fertilized by two sperm (dyspermia).

Risk factors

• age: after 35 years, the risk of developing chorionadenoma increases;
• history of previous chirion adenoma (especially if there were several);
• history of previous miscarriage;
• Vitamin A deficiency.

Symptoms of chorionadenoma

Chorionic adenoma causes symptoms of normal pregnancy (absence of menstrual cycle, breast engorgement, fatigue, frequent urination, morning sickness) and is diagnosed by ultrasound at an early stage. In addition, chorionadenoma causes other symptoms:

• vaginal discharge of tissue that is shaped like grapes (a characteristic feature of chorionadenoma);
• vaginal bleeding (light or heavy);
• too much enlargement of the uterus for early pregnancy;
• severe nausea and vomiting;
• Signs of hyperthyroidism include fatigue, weight loss, rapid heartbeat, sweating, irritability, anxiety, muscle weakness, and an enlarged thyroid gland.

But most of these symptoms can also indicate multiple pregnancies, miscarriage, and even a completely normal pregnancy.

Diagnosis of chorionadenoma

If you have symptoms of chorionadenoma, your doctor will perform an examination, order a blood test to determine the pregnancy hormone, and an ultrasound. Chorionic adenoma is also diagnosed early in pregnancy during a routine ultrasound or during treatment for an incomplete miscarriage.

Treatment of chorionadenoma

If you have been diagnosed with chorionadenoma, you should immediately undergo treatment and remove the intrauterine growth. After cleaning the uterus, you should periodically take tests (once or twice a year) for the presence of a trophoblastic tumor. Some women develop an ovarian cyst (benign) along with chorionadenoma.

Sometimes a trophoblastic tumor develops into cancer, which can be detected early only in the uterus and is treatable with chemotherapy. In cases of metastasis to other organs of the body, treatment involves chemotherapy and radiation.

Most women who have undergone treatment for trophoblastic disease have a chance of having a baby. With chorioadenoma, women are depressed and fearful of developing cancer. Contact a support group, talk to friends or a psychologist.

Chorioadenoma: Symptoms

Chorionic adenoma causes pregnancy symptoms - absence of menstrual cycle, breast tenderness, fatigue, frequent urination and morning sickness.

Contact your doctor immediately if you have signs of pregnancy and observe the following symptoms:

• Vaginal discharge of grape-shaped tissue (a characteristic symptom of chorionadenoma);
• Vaginal bleeding: Light bleeding in the first trimester is common in healthy pregnancies, but can also indicate chorionic vasculitis and miscarriage;
• severe nausea and vomiting (sometimes such symptoms also occur with chorionadenoma);
• Signs of an overactive thyroid include fatigue, weight loss, rapid heartbeat, sensitivity to heat, muscle weakness, and an enlarged thyroid gland.

Symptoms of choriodadenoma:

• high blood pressure, which is a sign of preeclampsia;
• absence of fetal heartbeat, since it is absent in both complete and partial chorionadenoma;
• atypical size of the uterus for the gestational age: a large increase in the uterus can only occur in a few cases - with chorionadenoma, multiple pregnancy, or when the woman herself does not know the gestational age.

Nowadays, chorionadenoma is diagnosed at an early stage of pregnancy using ultrasound. Therefore, in very rare cases, it provokes excessive enlargement of the uterus, nausea, vomiting, late toxicosis and symptoms of hyperthyroidism.

Chorionic Adenoma: Diagnosis and Tests

In most cases, it is possible to diagnose chorionadenoma at an early stage, so at the first signs you need to visit a doctor who will prescribe simple tests and conduct an examination, including:

• gynecological examination to determine the size of the uterus and identify pathology;
• a blood test to detect the amount of pregnancy hormone (human chorionic gonadotropin);
• Ultrasound to confirm the diagnosis (chorionadenoma is often diagnosed during an ultrasound examination prescribed for another purpose).

If chorionadenoma is diagnosed, the doctor will order additional blood and urine tests and a chest X-ray to identify:

• preeclampsia
• anemia
• cancer cells
• hyperthyroidism caused by chorionadenoma.

Chorionic Adenoma: Treatment Overview

The chorionadenoma is removed using vacuum aspiration under general anesthesia. The doctor simultaneously uses ultrasound to completely remove the pathological tissue. Before and after the procedure, oxytocin is prescribed to contract the uterus and return it to normal size, as well as to stop bleeding after the operation. If the Rh factor is negative, you should get a Rh antibody shot to prevent problems in the future. If you do not plan to have a child in the future, you can also consider removing the uterus, which reduces the risk of developing a trophoblastic tumor after chorionadenoma.

If you are at risk for developing cancer after chorionadenoma, you can prevent cell growth with the help of a medical drug - methotrexate.

In rare cases, a healthy fetus may develop in the uterus along with the chorionodema.

Subsequent rehabilitation

After removal of the chorionadenoma, you should regularly visit your doctor to detect cancerous tumors at an early stage. In this case, you should:

• every two weeks, take a blood test to check the level of human chorionic gonadotropin until the results are normal (high levels of the hormone indicate the presence of cancer cells);
• take contraceptives while monitoring hormone levels (human chorionic gonadotropin), which usually lasts 6 months.

Trophoblastic tumor

In most cases, trophoblastic tumors grow only in the uterine cavity. If you have been diagnosed with this tumor or are at risk for developing it, you will likely be prescribed one or more medications (methotrexate or actinomycin D). But if metastases are detected in other organs of the body, chemotherapy is used.

Fertility and rehabilitation after chorionadenoma

After removal of the chorionadenoma, the chances of a healthy pregnancy are the same as for most women, even after treatment for trophoblastic tumor. However, there is an increased risk of recurrence of the chorionadenoma. Therefore, you will be under the supervision of a doctor before and after pregnancy. The supervision includes:

• observation of the pregnant woman and ultrasound at the end of the first trimester to confirm a healthy pregnancy;
• Blood test for hormone levels (human chorionic gonadotropin) 6 weeks after the baby is born to rule out the development of a trophoblastic tumor.

Chorionic adenoma affects the emotional and physical state of a woman. The bitterness of pregnancy loss combined with the fear of developing cancer is difficult to bear. In such a case, it is necessary to enlist the support of friends, family members, and a psychologist to overcome this difficult period.

Chorionic Adenoma: Treatment at Home

Chorionic adenoma cannot be treated at home. After its removal, effective contraceptives should be taken to prevent pregnancy.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]