Pulmonary Deportation of Hydatidiform Mole: A 12-Year, Single Tertiary Center Experience in China

Pulmonary Deportation of Hydatidiform Mole: A 12-Year, Single Tertiary Center Experience in China

Hydatidiform mole, a form of gestational trophoblastic disease (GTD), encompasses a spectrum of conditions ranging from benign complete or partial moles to malignant gestational trophoblastic neoplasia (GTN). Among these, pulmonary deportation of hydatidiform mole is an exceedingly rare phenomenon, with limited understanding of its underlying mechanisms and optimal management strategies. This article presents a comprehensive review of a 12-year retrospective study conducted at Peking Union Medical College Hospital (PUMCH) in China, which aimed to elucidate the clinical features and rational treatment approaches for patients with benign molar pregnancies accompanied by pulmonary deportation.

The study included 20 patients diagnosed with hydatidiform mole and pulmonary deportation between November 2006 and May 2019. These patients were identified based on chest computed tomography (CT) scans showing suspected intrapulmonary micrometastases that spontaneously decreased in size, alongside normalized levels of beta-human chorionic gonadotrophin (b-hCG) during post-molar follow-up. The patients were managed without chemotherapy or further surgical intervention beyond uterine evacuation.

The median age of the patients was 29.0 years, with a median gravidity of 2 and parity of 1. The median gestational age at diagnosis of molar pregnancy was 10.3 weeks, and the median b-hCG level prior to uterine evacuation was 267,064.5 mIU/mL. Among the patients, 14 had complete moles and 6 had partial moles, as confirmed by immunohistochemical analyses. Initial pulmonary CT scans revealed suspected bilateral, left, and right chest deportation in 12, 4, and 4 patients, respectively, with the maximum nodular diameter ranging from 0.6 to 1.2 cm.

The management approach for these patients involved uterine evacuation followed by expectant management. The median duration to achieve a normal b-hCG level after the first evacuation was 15.5 weeks. Ten patients achieved complete resolution of their pulmonary lesions, while the remaining ten experienced a decrease in lesion size. The median time to achieve lesion resolution on chest CT after the first evacuation was 29.8 weeks, and the median time from the first normal b-hCG measurement to lesion resolution was 11.5 weeks.

The study also analyzed factors associated with the duration to achieve a normal b-hCG level after the first evacuation. No significant differences were observed based on patient age (≥40 years vs. 0.5 cm vs. ≤0.5 cm), or the number of uterine evacuations (once vs. twice or three times).

The findings of this study challenge the conventional notion of pulmonary metastasis in hydatidiform mole, suggesting that these lesions may represent benign deportation rather than malignant metastasis. The term “deportation” is more appropriate, as it reflects the benign nature of these lesions, which lack the capacity for unlimited growth or proliferation. This is supported by the fact that all patients achieved complete remission without chemotherapy or invasive interventions beyond uterine evacuation.

The study highlights the importance of close b-hCG surveillance in managing patients with pulmonary deportation of hydatidiform mole. The serum b-hCG level is a crucial marker for monitoring the risk of post-molar GTN. In this cohort, the median time to achieve the first normal b-hCG measurement was 15.5 weeks, with some patients requiring up to 42.9 weeks. This prolonged interval underscores the necessity of long-term follow-up to detect any potential progression to GTN.

The study also addresses the controversy surrounding the use of prophylactic chemotherapy and hysterectomy in patients with hydatidiform mole. The results suggest that neither chemotherapy nor hysterectomy is necessary for patients with pulmonary deportation, as expectant management following uterine evacuation is sufficient to achieve remission. This approach minimizes unnecessary toxic therapies and invasive procedures, balancing the future risk of GTN with patient safety.

A notable limitation of the study is the rarity of pulmonary deportation of hydatidiform mole, which limits the generalizability of the findings. Additionally, pre-treatment serum b-hCG levels and uterine size, which may influence the risk of GTN or the time to b-hCG regression, were partially missing due to the referral nature of the patients.

In conclusion, this 12-year retrospective study provides valuable insights into the clinical features and management of pulmonary deportation of hydatidiform mole. The findings support the concept of benign deportation rather than malignant metastasis, advocating for expectant management and close b-hCG surveillance. The study emphasizes the importance of reducing unnecessary toxic and invasive therapies, developing appropriate follow-up strategies, and improving the clinical identification of this rare entity. Collaborative international studies are encouraged to further enhance our understanding and management of this condition.

doi.org/10.1097/CM9.0000000000000950

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