Ultrasonographic Features of Hydatidiform Mole in a 35-Year-Old Woman Treated with Methotrexate: Imaging Findings and Drug-Induced Cutaneous Manifestations
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Submitted
15 January 2026
Published
10 February 2026
Keywords:
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gestational trophoblastic disease, uterus ultrasound, methotrexate, cutaneous adverse reactions, Mola hydatidosa
Abstract
Hydatidiform mole is a form of gestational trophoblastic disease (GTD) characterized by abnormal proliferation of trophoblastic tissue. It commonly presents with excessive uterine enlargement in early pregnancy and markedly elevated β-hCG levels. The spectrum of GTD comprises several pathologic entities, that originate from abnormal fertilization that leads to a proliferative process with similarities to the normal trophoblast. These entities include complete and partial hydatidiform moles, which constitutes more than 80% of cases; an invasive mole, which refers to persistent local disease after treatment; and choriocarcinoma, which constitutes 1% to 2% of cases. Early diagnosis and prompt management are crucial to prevent complications. This report describes a case of complete hydatidiform mole in a 35-years-old, in which diagnosis was primarily established through characteristic imaging findings, particularly on pelvic ultrasonography. The patient subsequently underwent methotrexate chemotherapy, with imaging also contributing to treatment monitoring and follow-up assessment. In addition, this report highlights the adverse effects of methotrexate, with particular emphasis on cutaneous manifestations.
References
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Berkowitz, R.S. & Goldstein, D.P. (2013) Clinical practice: molar pregnancy. New England Journal of Medicine, 368(9), pp. 789–798.
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Paus R, Cotsarelis G. (1999). The biology of hair follicles. N Engl J Med. Aug 12;341(7):491-7. doi: 10.1056/NEJM199908123410706. PMID: 10441606.
Biswal SG, Mehta RD. (2018). Cutaneous Adverse Reactions of Chemotherapy in Cancer Patients: A Clinicoepidemiological Study. Indian J Dermatol. 2018 Jan-Feb;63(1):41-46. doi: 10.4103/ijd.IJD_65_17. PMID: 29527024; PMCID: PMC5838753. https://pmc.ncbi.nlm.nih.gov/articles/PMC5838753/
Iris Bonomo, Suzy Fopa, et al. (2024). Giant Complete Hydatidiform Mole: A Case Report and Review of The Literature. Journal of Medical Case Reports. 18:277. https://doi.org/10.1186/s13256-024-04474-7
Avisena Specialist Hospital. (2025). https://awcsh.avisena.com.my/health-articles/gestational-trophoblastic-disease-symptoms-treatment-more/
Nasution RA, Algifari MZ, Zulfadli. (2024). Usia Lebih dari 40 Tahun sebagai Faktor Risiko Mola Hidatidosa: Laporan Kasus. Journal of Medula, Volume 14, Nomor 6, Hal. 1185-89. http://www.journalofmedula.com/index.php/medula/article/view/1150/910
Mulisya O, Roberts DJ, Sengupta ES, Agaba E, Laffita D, Tobias T, Mpiima DP, Henry L, Augustine S, Abraham M, Hillary T, Mugisha J. (2018). Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital. Obstet Gynecol Int. 2018 Apr 1;2018:9561413. doi: 10.1155/2018/9561413. PMID: 29805452; PMCID: PMC5901474. https://pmc.ncbi.nlm.nih.gov/articles/PMC5901474/
C. A. R. LOK, A. F. Zurcher, J. Van Der Velden. (2005). A Case of A Hydatidiform Mole in A 56-Year-Old Woman. International Journal of Gynecological Cancer. 15, 163—166. https://www.international-journal-of-gynecological-cancer.com/article/S1048-891X(24)04458-X/pdf
Newhouse I, Spacey A, Scragg B, Szczepura K. (2022). The diagnostic value and accuracy of ultrasound in diagnosing hydatidiform mole: A systematic review and meta-analysis of the literature. Radiography. Volume 28, Issue 4, 897-905. ISSN 1078-8174. https://doi.org/10.1016/j.radi.2022.06.005.
Bhargava S. dan Bhargava S. (2013). Chapter 20. Gynecology and Obstetrics. Differential Diagnosis in Ultrasound 2nd edition. New Delhi: Jaypee Brothers Medical Publishers. Pg.552-3.
Yigiter AB, Kavak ZN (2008). Chapter 3. Early Normal and Abnormal Pregnancy. Donald School Basic Textbook of Ultrasound in Obstetrics and Gynecology. New Delhi: Jaypee Brothers Medical Publishers. Pg.64.
Radiology Key. (2025). Chapter Uterus: Endometrium, Sonography. https://radiologykey.com/uterus-2/
Lin LH, Bernardes LS, Hase EA, Fushida K, Francisco RP. (2015). Is Doppler ultrasound useful for evaluating gestational trophoblastic disease? Clinics. 70(12):810-815.
Berkowitz, R.S. & Goldstein, D.P. (2013) Clinical practice: molar pregnancy. New England Journal of Medicine, 368(9), pp. 789–798.
NCCN (2019) NCCN Clinical Practice Guidelines in Oncology: Gestational Trophoblastic Neoplasia. Version 2.
Ngan, H.Y.S. et al. (2021) Diagnosis and management of gestational trophoblastic disease: FIGO consensus update. International Journal of Gynecology & Obstetrics, 155(S1), pp. 86–93.
Seckl, M.J., Sebire, N.J. & Berkowitz, R.S. (2010) Gestational trophoblastic disease. Lancet, 376(9742), pp. 717–729.
Pulito, C., Cristaudo, A., Porta, C.L. et al. Oral mucositis: the hidden side of cancer therapy. J Exp Clin Cancer Res 39, 210 (2020). https://doi.org/10.1186/s13046-020-01715-7 https://link.springer.com/article/10.1186/s13046-020-01715-7
Miglani S, Daljit T, Srivastava A, Rathi A.K. (2025). Acute cutaneous adverse effects of methotrexate: A case report highlighting therapeutic challenges. Toxicology Reports, Volume 15, December 2025, 102108, https://doi.org/10.1016/j.toxrep.2025.102108. https://www.sciencedirect.com/science/article/pii/S2214750025002276
Goerttler E., Kutzner H., Peter H.H., Requena L. (1999). Methotrexate-induced papular eruption in patients with rheumatic diseases: A distinctive adverse cutaneous reaction produced by methotrexate in patients with collagen vascular diseases. Journal of the American Academy of Dermatology, Volume 40, Issue 5, Pages 702-707, ISSN 0190-9622, https://doi.org/10.1016/S0190-9622(99)70150-7.
Hussain F, Gnanappiragasam D, Shaffrali F. Chemotherapy-related striate melanonychia: a case report. J Med Case Rep. 2021 Jan 31;15(1):27. doi: 10.1186/s13256-020-02612-5. PMID: 33516241; PMCID: PMC7847596. https://pmc.ncbi.nlm.nih.gov/articles/PMC7847596/
Sinha P, Bhatt S, Radhakrishnan S, Neema S, Sinha A. (2020). Anagen Effluvium after Methotrexate: An Idiosyncratic Reaction. Int J Trichology. Mar-Apr;12(2):93-96. doi: 10.4103/ijt.ijt_49_20. Epub 2020 May 5. PMID: 32684684; PMCID: PMC7362964. https://pmc.ncbi.nlm.nih.gov/articles/PMC7362964/
Paus R, Cotsarelis G. (1999). The biology of hair follicles. N Engl J Med. Aug 12;341(7):491-7. doi: 10.1056/NEJM199908123410706. PMID: 10441606.
Biswal SG, Mehta RD. (2018). Cutaneous Adverse Reactions of Chemotherapy in Cancer Patients: A Clinicoepidemiological Study. Indian J Dermatol. 2018 Jan-Feb;63(1):41-46. doi: 10.4103/ijd.IJD_65_17. PMID: 29527024; PMCID: PMC5838753. https://pmc.ncbi.nlm.nih.gov/articles/PMC5838753/
Authors
Sutikno, D. A. (2026). Ultrasonographic Features of Hydatidiform Mole in a 35-Year-Old Woman Treated with Methotrexate: Imaging Findings and Drug-Induced Cutaneous Manifestations. Journal of Midwifery and Health Science of Sultan Agung, 5(1), 1–16. Retrieved from https://www.jmhsa.id/index.php/jmhsa/article/view/149
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