Breus' mole

Breus' mole is a massive, subchorionic, tuberous hematoma, formed out of maternal blood in the uterus in pregnancy. It was first described by Karl Breus in 1892.[1][2][3]

Breus' mole
Other namesOva tuberculosa, massive mole
SpecialtyObstetrics

Cause and pathogenesis

It is a rare disease, with an incidence of 1 in 1200 placentas.[4] Women with cardiac problems, disorders of circulation, monosomy, hypertension and diabetes are predisposed to Breus' mole. The mole is formed as a sub-chorionic hematoma, formed out of the intervillous blood, causing progressive accumulation of the clotting substance called fibrin with increasing gestational age. Evidence from Southern blot test reveals that 85 percent of the clotted material is maternal blood. Breus mole is reported to be found in the placetae of macerated stillborn foetuses, indicating that massive subchorionic hematoma could have been the cause of their demise.[5] A massive Breus' mole can cause disturbances in blood flow in the spiral arteries and might result in intrauterine growth restriction of the foetus.

Diagnosis

Clinically, Breus' mole may be asymptomatic, or may present with signs of decreased blood flow to the foetus such as growth restriction and foetal distress. Postnatally, Breus' mole is found in placental examination following live birth or spontaneous abortion. Breus' mole is diagnosed antenatally by ultrasound, where a thick multilobulated hematoma can be seen beneath the chorion. Occasionally, subchorial thrombohematoma may later become intraplacental, making its diagnosis difficult. The mole may be echogenic or hypoechoic depending upon the amount of fresh blood present in it.[6] Breus' mole should be differentiated from vesicular mole and missed abortion in an ultrasound examination.

Prognosis

Foetal demise occurs if the circulating blood volume is decreased significantly. The critical factor deciding the prognosis is the site of the hematoma and not the volume.[7] If discovered antenatally, serial USG and/or Doppler scans is indicated to monitor the size of the hematoma and well-being of the foetus.

References
  1. Madu AE (2009). "Breus' mole in pregnancy". Journal of Obstetrics and Gynaecology. 26 (8): 815–816. doi:10.1080/01443610600987035. ISSN 0144-3615.
  2. Von Der Ahe, CV (1965). "The Breus mole". American Journal of Obstetrics and Gynecology. 92 (5): 699–701. doi:10.1016/0002-9378(65)90442-4. ISSN 0002-9378.
  3. Shanklin DR, Scott JS (June 1975). "Massive subchorial thrombohaematoma (Breus' mole)". Br J Obstet Gynaecol. 82 (6): 476–87. PMID 166651.
  4. Benirschke K, Peter Kaufmann P (2013-06-29). Pathology of the Human Placenta. Springer Science & Business Media. p. 243. ISBN 978-1-4757-4196-4.
  5. Kim DT, Riddell DC, Welch JP, Scott H, Fraser RB, Wright JR (2002). "Association between Breus' mole and partial hydatidiform mole: chance or can hydropic villi precipitate placental massive subchorionic thrombosis?". Pediatr Pathol Mol Med. 21 (5): 451–9. doi:10.1080/02770930290097507. PMID 12396900.
  6. Suchet IB (2013). "Breu's Mole". The Ultrasound of Life.
  7. Kojima K, Suzuki Y, Makino A, Murakami I, Suzumori K (2001). "A case of massive subchorionic thrombohematoma diagnosed by ultrasonography and magnetic resonance imaging". Fetal Diagn. Ther. 16 (1): 57–60. doi:10.1159/000053882. PMID 11125254.
Classification
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