Radiology_May04 43 SA JOURNAL OF RADIOLOGY • May 2004 CASE REPORT Introduction This case emphasises the role of sonography in the diagnosis of a com- plete molar pregnancy. Case report A 53-year-old female, para 13 gravid 13, presented to the casualty department of Pretoria Academic Hospital with a complaint of PV (per vagina) bleeding. On clinical examination she was found to be anaemic and had an enlarged, 20 cm uterus, with adnexal tenderness. Routine blood tests were normal, except for a B-HCG level of 843 636 IU/l. On transabdominal sonar the uterus measured approximately 23 cm in length x 12 cm in width with hyperechoic vesicular contents and densely packed multiple small cysts. No fetus was found. The rest of the abdomen and pelvis were normal. A diagnosis of complete molar pregnan- cy was made (Figs 1a and b). The patient underwent a total abdominal hysterectomy and the diagnosis was subsequently con- firmed on histological examination. Discussion Complete molar pregnancy is part of the spectrum of disorders charac- terised by abnormal proliferation of pregnancy-related trophoblasts. It is characterised by chromosomal DNA exclusively of paternal origin. It occurs when a normal haploid sperm fertilis- es an ovum with absent or inactive maternal chromosomes. The aetiology is unknown, but sev- eral factors play a role. These include folic acid-deficient diet, age younger than 20 years or older than 40 years. The incidence among women older than 50 years is 1:2 pregnancies.1 At pathology there is no fetal devel- opment and the placenta is entirely replaced by abnormal, hydropic chorionic villi with excessive tro- phoblastic proliferation. It is characterised by excessive uter- ine size, as well as B-HCG levels in the 100 000s IU/l (normal pregnancy val- ues are ± 60 000 IU/l), hyperemesis gravidarum, toxaemia, hyperthy- roidism and respiratory failure. Vaginal bleeding exists in over 90% of cases.2 Sonographic features Sonographic features include: (i) enlarged uterus containing echogenic tissue expanding into the endometrial cavity; (ii) uniformly distributed cys- tic spaces; (iii) no fetus; and (iv) bilat- eral greatly enlarged ovaries with mul- tiple theca lutein cysts.2 Treatment depends on the patient's age. In patients over 40 years the treat- ment of choice is total abdominal hys- terectomy. Patients younger than 40 years are treated with suction curet- tage. Both groups are followed up with serial B-HCG measurements and ultrasound.1 References 1. Nel JT. Core Obstetrics and Gynaecology. Johannesburg: Heinemann, 1996: 599-606. 2. Rumack CM, Wilson SR, Charboneau JW. Diagnostic Ultrasound. 2nd ed. USA: Mosby, 1997: 1359-1362. Complete molar pregnancy in a 53-year-old woman Narosha Adroos MB ChB Department of Diagnostic Radiology Pretoria Academic Hospital Fig. 1a. Transabsominal transverse scan showing a vesicular echogenic mass filling the endometrial cavity. Fig. 1b. Transabdominal longitudinal scan.