Abstract A persistent sciatic artery (PSA) is a rare anomaly and it is an embryologic remanent of the internal iliac artery, occurring in five different forms, depending on its relationship with the superficial femoral artery (SFA). Physicians must acknowledge the existence of this anomaly, and it should be included in the differential diagnosis of lower limb ischemia. We present the case of a 56-year-old female who presented with a popliteal artery acute ischemic event. Angiography showed a hypoplastic right SFA with a patent PSA vascularizing the lower extremity. A conventional embolectomy through a P1 popliteal incision was auspiciously performed. A magnetic resonance angiography confirmed a PSA of the right lower extremity during the post-operative period. At 12-month follow-up, the patient is well and asymptomatic.

Resumen Una arteria ciática persistente es una anomalía rara y un remanente embriológico de la arteria ilíaca interna. Se presenta en cinco formas diferentes, dependiendo de su relación con la arteria femoral superficial. Los médicos deben reconocer la existencia de esta anomalía y debe incluirse en el diagnóstico diferencial de isquemia de miembros inferiores. Presentamos el caso de una mujer de 56 años que consultó por un evento isquémico agudo de la arteria poplítea. La angiografía mostró una arteria femoral superficial derecha hipoplásica con una arteria ciática permeable persistente que vascularizaba la extremidad inferior. Se realizó auspiciosamente una embolectomía convencional a través de una incisión poplítea P1. Una angiografía por resonancia magnética confirmó una arteria ciática persistente de la extremidad inferior derecha durante el postoperatorio. A los 12 meses de seguimiento, la paciente se encuentra bien y asintomático.

The existence of the geomagnetic field is widely known by the community, as since childhood there is contact with compasses and the compass rose, always highlighting its usefulness for location on the Globe, especially in marine and air environments. Despite being mapped for centuries, its declination and inclination properties are often overlooked through the claim that the compass deviation from the meridian is usually small – and tends to be in equatorial regions. Other properties such as the South Atlantic Magnetic Anomaly (SAMA) are little known to the population. This work presents a medium depth look at geomagnetism and provides a computational tool whose objective is to reduce the distance between little-known aspects about the geomagnetic field and students in the initial years of undergraduate courses in the areas of exact and Earth sciences. community rose Globe environments centuries regions SAMA (SAMA population littleknown sciences

A existência do campo geomagnético é amplamente conhecida pela comunidade, pois desde a infância há o contato com as bússolas e a rosa dos ventos, evidenciando sempre sua utilidade para a localização no Globo, especialmente nos meios marinhos e aéreos. Apesar de mapeado há séculos, suas propriedades de declinação e inclinação costumam ser negligenciadas por meio da afirmação de que o desvio da bússola para o meridiano costuma ser pequeno – e tende a ser nas regiões equatoriais. Já outras propriedades, como a Anomalia Magnética do Atlântico Sul (SAMA) são pouco conhecidas da população. Este trabalho apresenta um olhar de média profundidade sobre o geomagnetismo, e disponibiliza uma ferramenta computacional cujo objetivo é diminuir a distância entre aspectos pouco conhecidos acerca do campo geomagnético e os alunos dos anos iniciais dos cursos de graduação nas áreas de ciências exatas e da Terra. comunidade ventos Globo aéreos séculos equatoriais SAMA (SAMA população geomagnetismo Terra

Resumen El Lago de Cuitzeo se encuentra en la parte central del Cinturón Volcánico Trans Mexicano, en una región de extensión asociada al graben de Cuitzeo, en donde el ascenso magmático parece proporcionar las fuentes de calor que alimentan a las manifestaciones geotérmicas superficiales. Se observa una distribución profusa de andesitas a través del área de estudio de 50 × 50 km2. Se calculan inversiones 3D de los campos de gravedad y magnético para obtener distribuciones de densidad y susceptibilidad magnética hasta 7000 m de profundidad, de las cuales obtenemos y analizamos secciones N-S y E-W, obteniendo también geo-superficies que ayudan a caracterizar las áreas de anomalía de interés. Utiliza-mos datos derivados de observaciones satelitales de gravedad y magnetismo debido a sus características de alta resolución y cobertura uniforme del área de estudio. El análisis se inicia con la región de San Agustín del Maíz (SAM), que exhibe manifestaciones geotérmicas superficiales, para caracterizar sus propiedades de densidad y susceptibilidad, y después el análisis se extiende a toda el área de estudio. Varios sitios en donde afloran regiones de baja susceptibilidad magnética, como en 46 el caso de SAM, se sugieren como blancos potenciales de exploración geotérmica. Dos geo-superficies de densidad apuntan a dos volúmenes en donde material magmático puede estar emplazado, coincidiendo con la presencia de fallas geológicas activas. El análisis presentado aquí puede extenderse a regiones vecinas al Lago de Cuitzeo, y pueden constituir una metodología de exploración rápida y económica en distritos geotérmicos similares.

Abstract Cuitzeo Lake, in the central part of the Trans Mexican Volcanic Belt, is in an extensional region associated with the Cuitzeo graben, where magmatic ascent appears to provide the heat sources for the surface, geothermal manifestations. A profuse distribution of andesitic rocks is observed throughout the study area of 50×50 km2. Gravity and magnetic field 3D inversions are calculated to obtain density and magnetic susceptibility distributions to 7000 m depth, from which we analyze N-S and E-W cross-sections and obtain density and magnetic susceptibility geosurfaces that help characterize anomaly areas of interest. We use satellite-derived gravity and magnetic data in our evaluation, owing to their high-resolution characteristics and uniform coverage of the study area. Analysis initiates with the San Agustín del Maíz region (SAM), exhibiting surface geothermal manifestations, to characterize its density and susceptibility characteristics, then the analysis is extended to the whole study area. Several outcropping, low magnetic susceptibility regions, like the one associated with SAM, are suggested as potential geothermal targets. Density geosurfaces point to two volumes where magmatic material may intrude, coinciding with active geologic faults. The analysis presented here can be extended to neighboring regions in the Cuitzeo Lake area and may constitute a fast, unexpensive exploration methodology in similar geothermal districts.

ABSTRACT Purpose Horseshoe kidney (HSK) is the most common renal fusion anomaly, occurring in 0.25% of the population (1). It presents technical obstacles to pyeloplasty for ureteropelvic junction obstruction (UPJO) despite robotic assistance (2, 3). KangDuo-Surgical-Robot-01 (KD-SR-01), an emerging robotic platform in China, has yielded satisfactory outcomes in pyeloplasty (4, 5). We first describe our modified technique of robotic bilateral pyeloplasty for UPJO in HSK using KD-SR-01 system in the Lithotomy Trendelenburg position. Materials and Methods A 36-year-old man with HSK and bilateral UPJO suffered right flank pain due to renal calculi (Figure-1). Repeated double-J stent insertion and ureteroscopy lithotripsy did not relieve his symptoms. A robot-assisted modified bilateral dismembered V-shaped flap pyeloplasty was performed using KD-SR-01 system in the Lithotomy Trendelenburg position. Results Total operative time was 298 minutes with 50 ml estimated blood loss. There was no conversion to laparoscopic or open surgery. A follow-up of 14 months showed relieving symptoms and stable renal function. Cine magnetic resonance urography and computed tomography urography revealed improved hydronephrosis and good drainage. No intraoperative or postoperative complications occurred. Conclusions It is technically feasible to perform a KD-SR-01-assisted modified bilateral dismembered V-shaped flap pyeloplasty in the Lithotomy Trendelenburg position for HSK. This procedure achieves managing UPJO on both sides without redocking the system and provides a wider operative field. In addition, it may be associated with better ergonomics, better cosmetic outcomes, and less possibility of postoperative bowel adhesion. However, further investigation is still warranted to confirm its safety, efficacy, and advantages over traditional procedures. (HSK anomaly 025 0 25 0.25 1. 1 . (1) (UPJO 2, 2 (2 3. 3 3) KangDuoSurgicalRobot01 KangDuoSurgicalRobot KangDuo Surgical Robot 01 KangDuo-Surgical-Robot-0 KDSR01, KDSR01 KDSR KD SR , (KD-SR-01) China 4, 4 (4 5. 5 5) KD-SR-0 36yearold yearold 36 year old Figure1. Figure1 Figure (Figure-1) doubleJ double J robotassisted robot assisted Vshaped V shaped 29 loss surgery followup follow up function drainage occurred KDSR01assisted KDSRassisted field addition ergonomics adhesion However safety efficacy procedures 02 0.2 (1 ( KangDuoSurgicalRobot0 KangDuo-Surgical-Robot- KDSR0 (KD-SR-01 KD-SR- (Figure-1 0. KangDuo-Surgical-Robot (KD-SR-0 KD-SR (Figure- (KD-SR- (Figure (KD-SR

In this work, considering a simplified model we estimate the magnetic moment m ¯ associated to two neodymium magnets with different geometries. We investigated how the effect of temperature modifies magnetic properties, such as the intensity of the magnetic field evaluated at the extreme of these magnets, based on these results we present a fictitious anomaly as an didactic purpose inspired by the discussion built throughout the work, which allows illustrating a current problem in the scenario of high energy physics, known as the muon (g-2) anomaly. work geometries properties physics g2 g 2 (g-2 (g- (g

Neste trabalho, considerando um modelo simplificado, estimamos o momento magnético m ¯, associado a dois ímãs de neodímio com diferentes geometrias. Investigamos como o efeito da temperatura modifica propriedades magnéticas, como a intensidade do campo magnético avaliada no extremo destes magnetos, a partir destes resultados apresentamos uma anomalia fictícia de cunho didático inspirado na discussão construída ao longo do trabalho, que permite ilustrar um problema atual no cenário de física de altas energias, conhecido como anomalia (g-2) do múon. trabalho simplificado ¯ geometrias magnéticas magnetos energias g2 g 2 (g-2 múon (g- (g

Resumen ANTECEDENTES: Las anomalías uterinas congénitas son consecuencia de la formación anormal, fusión o reabsorción de los conductos de Müller durante el desarrollo embriológico. El útero bicorne, unicorne y didelfo (U1, U2, U3 ESHRE-ESGE) son defectos en la unificación con una baja prevalencia en la población general y en la que tiene antecedente de aborto e infertilidad; se estima en alrededor de 0.4 a 1.1%, respectivamente. La presentación del caso puede aportar información útil relacionada con la evolución del embarazo y los desenlaces perinatales cuando aparece esta anomalía. CASO CLÍNICO: Paciente de 35 años, con amenorrea secundaria y prueba inmunológica de embarazo positiva, con antecedentes de dismenorrea primaria severa y anomalía uterina congénita compatible con útero bicorpóreo (U3 completo ESHRE-ESGE), bicorne completo (4a-AFS) y didelfo. El embarazo trascurrió sin complicaciones hasta la semana 37, cuando finalizó mediante cesárea, con hipotonía uterina que no ameritó transfusión de hemoderivados. CONCLUSIÓN: Los embarazos gemelares con útero bicorne son excepcionales y casi todos se logran espontáneamente; los que llegan a término finalizan mediante cesárea electiva.

Abstract BACKGROUND: Congenital uterine anomalies are the result of abnormal formation, fusion, or resorption of the Müllerian ducts during embryological development. The bicornuate, unicornuate and didelphic uterus (U1, U2, U3 ESHRE/ESGE), are unification defects with a low prevalence both in the general population and in the population with a history of abortion and infertility, is estimated at around 0.4 to 1.1%, respectively. The presentation of the case can provide useful information related to with the evolution of the pregnancy and the perinatal outcomes when this anomaly appears. CLINICAL CASE: A 35-year-old patient with secondary amenorrhea and a positive immunological pregnancy test with a history of severe primary dysmenorrhea and previous magnetic resonance imaging with a congenital uterine anomaly compatible with a bicorporeal uterus (U3 complete ESHRE-ESGE), complete bicornuate (4a /AFS) , uterus didelphys (ASRM). The pregnancy was uncomplicated until 37 weeks, when it was terminated by cesarean section, with uterine hypotonia that did not require transfusion of blood products. CONCLUSION: Twin pregnancy with bicornuate uterus is a rare entity, most of them have been achieved spontaneously and those that reach term have been resolved by elective cesarean section.

Abstract: Introduction: Mayer-Rokitansky-Küster-Hauser syndrome (also known as müllerian aplasia) is a rare congenital anomaly of the tract genital, of unknown etiology, characterized by the congenital absence of the uterus, cervix and upper portion of the vagina. Clinical case: A 16-year-old female patient with primary amenorrhea, normal hormonal profile, adequate sexual development Tanner 5, 46 XX karyotype. A magnetic sound is performed where the absence of the uterus and the proximal two-thirds of the vagina are detected. Conclusion: Magnetic resonance is a diagnostic test that provides great anatomical detail of the uterus and vagina, allowing to correctly characterize and classify Müllerian anomalies.

Resumen: Introducción: El síndrome de Mayer-Rokitansky-Küster-Hauser (también conocido como aplasia mülleriana) es una rara anomalía congénita del tracto genital, de etiología desconocida, se caracteriza por la ausencia congénita del útero, cérvix y porción superior de la vagina. Caso clínico: Paciente femenino de 16 años de edad que presenta amenorrea primaria, perfil hormonal normal, desarrollo sexual adecuado Tanner 5, cariotipo 46 XX. Se realiza resonancia magnética, donde se detecta ausencia de útero y de los dos tercios proximales de la vagina. Conclusión: La resonancia magnética es una prueba diagnóstica que brinda gran detalle anatómico del útero y vagina, permitiendo caracterizar y clasificar correctamente a las anomalías müllerianas.

Abstract Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly of the female urogenital tract, characterized by the triad of bicorporeal uterus, obstructed hemivagina and ipsilateral renal agenesis. The most common symptoms are pelvic pain, dysmenorrhea and an abdominal mass. Prompt surgical treatment is advisable. If not immediately possible, medical treatment should be initiated to induce amenorrhea. We describe a case of HWW with chronic pelvic pain and mild dysmenorrhea. The ultrasound revealed uterine duplication and a retro-uterine mass contiguous to the cervix. Magnetic resonance imaging (MRI) confirmed a genital tract anomaly. The patient was medicated with continuous oral estroprogestative and was proposed to surgery.

Resumo O Síndrome de Herlyn-Werner-Wunderlich (HWW) é uma anomalia congénita rara do trato urogenital feminino, caraterizada pela tríade de útero bicorporal, hemivagina obstruída e agenesia renal ipsilateral. Os sintomas mais comuns são a dor pélvica, dismenorreia e presença de massa abdominal. É recomendado o tratamento cirúrgico atempado. No caso de impossibilidade, deve ser iniciado tratamento médico para indução da amenorreia. Descreve-se um caso de HWW em doente com dor pélvica crónica e dismenorreia ligeira. Ecograficamente constatada duplicação uterina e a presença de uma massa retro-uterina contigua ao colo uterino. A ressonância magnética confirmou a presença de malformação uterina. A doente foi medicada com estroprogestativo oral contínuo e proposta para cirurgia.

Abstract Ectopic pancreatic tissue or heterotopic pancreas is a congenital or acquired anomaly in which there is pancreatic tissue not connected to the main gland. It has an uncertain prevalence since it is generally an incidental finding and is located mainly in the upper gastrointestinal tract. We present the case of a 51-year-old woman with jejunal ectopic pancreas with associated inflammatory changes, studied with computed tomography and magnetic resonance imaging, and subsequent histopathological confirmation.

Resumen El tejido pancreático ectópico o páncreas heterotópico es una anomalía congénita o adquirida en la cual encontramos tejido pancreático no conectado a la glándula principal. Presenta una prevalencia incierta, ya que por lo general es un hallazgo incidental y se ubica principalmente en el tracto gastrointestinal superior. Presentamos el caso de una mujer de 51 años con páncreas ectópico yeyunal y cambios inflamatorios asociados, estudiada con tomografía computada y resonancia magnética, y posterior confirmación histopatológica.

ABSTRACT Introduction: The transverse vaginal septum (TVS) with congenital urethra-vaginal fistula (CUVF) is a rare anomaly of the mullerian duct (1, 2). Incomplete channelling of the vaginal plate, or an abnormality in the fusion of the vaginal component of mullerian duct with the urogenital sinus results in TVS (1, 3, 4). High CUVF occurs due to the persistent communication between the urogenital sinus and utero-vaginal primordium at the tubercle sinus, whereas low CUVF is due to excessive apoptosis of the vaginal plate during channelling (5). The principles of management of CUVF with TVS include: 1) TVS resection, 2) Create a neovagina. We present a case of CUVF with TVS managed by robotic assistance. Material and methods: A 24-year-old female, married for 3 years, presented with cyclical hematuria since menarche, dyspareunia and primary infertility. Examination revealed blind ending vagina 4cm from the introitus. Magnetic resonance imaging revealed a fistulous communication between urethra and vagina, and TVS. Cystourethroscopy confirmed a proximal urethra-vaginal fistula. Urethroscopy guided puncture of the TVS was performed, tract dilated and a catheter was placed across it. Robotic assisted transvaginal approach was planned. Air docking of robot was performed. Traction on the catheter was given to identify the incised edges of the septum. Vaginal flaps were raised laterally, fistulous tract was excised. Proximal vagina mucosa was identified and vaginoplasty was performed. Result: Patient’s postoperative recovery was uneventful. Urethral catheter was removed after 5 days. She had normal voiding and menstruation. Vaginoscopy performed at 1st month follow-up, revealed an adequate vaginal lumen. Vaginal moulds were advised for 6 weeks during the night, following which she resumed her sexual activity. She conceived 6 months post-surgery, and delivered a child by caesarean section. Conclusion: We successfully managed this case by resection of septum, neovagina creation and thereby achieving normal menstruation and conception. The advantages of robotic approach were magnification, precision and manoeuvrability in a limited space, avoiding a vaginal release incision.

ABSTRACT The canal of nuck cyst is a rare congenital anomaly caused by the persistence of the vaginalis process, which comes from the parietal peritoneum that accompanies the round ligament within the inguinal canal of women. The male equivalent would be hydrocele. This entity commonly causes confusion with an inguinal hernia since it manifests as an inguinal or even genital bulge and its usual diagnosis is by ultrasound, CT, magnetic resonance imaging and sometimes even intra-surgical. There is consensus that its treatment should be surgical. Knowledge of this pathology in primary care helps to make a better differential diagnosis. We report the case study of a young woman who came to the consultation with a painful groin lump that worsened with standing, and was partially reduced. A hernia was suspected that turned out to be a Nuck cyst.

RESUMEN El quiste del canal de Nuck es una anomalía congénita infrecuente producida por la persistencia del proceso vaginalis, que procede del peritoneo parietal que acompaña al ligamento redondo dentro del canal inguinal de la mujer. El equivalente masculino sería el hidrocele. Esta entidad frecuentemente produce confusión con una hernia inguinal, ya que se manifiesta como bulto inguinal o incluso genital y su diagnóstico habitual es por ecografía, tomografía axial computarizada (TAC), resonancia nuclear magnética (RNM) y a veces incluso intraquirúrgico. Existe consenso en que su tratamiento debe ser quirúrgico. El conocimiento de esta patología en Atención Primaria ayuda a realizar un mejor diagnóstico diferencial. Presentamos el caso clínico de una mujer joven que acude a consulta con un bulto inguinal doloroso que empeora con la bipedestación y se reduce parcialmente, sospechoso de hernia, que resultó ser un quiste de Nuck.

Duplication of the common bile duct (CBD) is a rare congenital anomaly of the bile ducts that should be diagnosed prior to surgery in order to optimise management and prevent complications. We report a case of a patient presenting with choledocholithiasis and type Va duplicated extrahepatic bile duct that was missed on ultrasonography. The atypical course prompted further imaging with magnetic resonance cholangiopancreatography (MRCP), which identified the aberrant bile duct and assisted in safe preoperative and operative management. This case highlights the importance of accurate pre-interventional imaging and agrees with the reclassification of duplications of the CBD.

Abstract: Pituitary stalk disruption syndrome is a congenital anomaly characterized by neuroradiologic demonstration of an absent, interrupted, or hypoplastic pituitary stalk, aplastic/ hypoplastic adenohypophysis, and ectopic neurohypophysis. This syndrome has been related to severe forms of congenital hypopituitarism, associated with multiple deficiencies of pituitary hormones. Perinatal signs and symptoms presented by patients include hypoglycemia in up to 61%, jaundice in 38%, micropenis in 77% and cholestasis in 19%, neonatal seizures occurred in 75% of children. During childhood, they tend to have short stature and a decrease in growth speed, as well as a delay in the expression of secondary sexual characteristics. In our clinical case, an adolescent patient was presented whose main clinical manifestations were delayed secondary sexual characteristics, the main findings were found in nuclear magnetic resonance, including absence of the pituitary stalk, ectopic neurohypophysis, located adjacent to the tuber cinereum and hypoplastic adenohypophys.

Resumen: El síndrome de interrupción del tallo pituitario es una anomalía congénita que se caracteriza por la demostración neurorradiológica de un tallo pituitario ausente, interrumpido o hipoplásico, adenohipófisis aplásica/hipoplásica y neurohipófisis ectópica. Este síndrome se ha relacionado con formas severas de hipopituitarismo congénito, asociado a múltiples deficiencias de hormonas pituitarias. Los signos y los síntomas perinatales que presentan los pacientes incluyen hipoglucemia hasta en un 61%, ictericia en un 38%, micropene en un 77% y colestasis en un 19%, las convulsiones neonatales se dieron en el 75% de los niños. Durante la infancia suelen tener talla baja y disminución en la velocidad del crecimiento, así mismo pueden presentar retardo en la expresión de los caracteres sexuales secundarios 1. En nuestro caso clínico se trata de un paciente adolescente el cual tenía como manifestaciones clínicas principales, retardo en los caracteres sexuales secundarios, los hallazgos principales que se encontraron en la resonancia magnética nuclear, incluyeron ausencia del tallo hipofisario, neurohipófisis ectópica, localizada adyacente al túber cinereum y adenohipofisis hipoplásica.

Abstract We present airborne magnetic and radiometric characteristics of some igneous suites from the Ponta Grossa Arch Alkaline Province (southern Brazil), namely the Bairro da Cruz, Banhadão, Barra do Itapirapuã, Mato Preto and Tunas complexes, Barra do Teixeira Phonolite, Itapirapuã Nepheline syenite, and José Fernandes Gabbro. We applied magnetic susceptibility 3D inversions using the total magnetic anomaly data together with its analytic signal of the vertical integral and the vertical integral of the analytic signal for the Bairro da Cruz, José Fernandes, and Tunas intrusions. Gamma-ray spectrometric methods involved analyses of basic, ternary, and ratio maps, thorium-normalized parameters, and radioelement concentrations at sampled data points. Stacked profiles from geophysical data were generated for each rock. The Bairro da Cruz, José Fernandes, and Tunas intrusions are associated with dipolar anomalies with normal polarity whereas their inversions show low magnetic susceptibility values. Gamma-ray spectrometric results allowed us to verify that all complexes are enriched mainly in eTh. Carbonatite bodies showed the highest contents of eTh and eU. Our findings are consistent with geophysical responses of alkaline bodies and impact the understanding of geophysical signatures, especially radiometric ones, of alkaline provinces in Brazil.

Abstract BACKGROUND: The incidence of twin pregnancies with hydatidiform mole is 1 case in 20,000 to 100,000 pregnancies. The complete hydatidiform mole originates from an empty ovum, without maternal genetic material, fertilized by a sperm, which duplicates its genetic material. In the ultrasound a pattern in “snowflakes” is observed. There are two types of care: expectant management or termination of pregnancy, in both situations with prior assessment of potential maternal risks. Any decision must be made in conjunction with the patient and the obstetrician. CLINICAL CASE: 43-year-old patient, who underwent assisted reproduction techniques to achieve pregnancy, the one achieved was: twin, bichorionic and bi-amniotic. Subsequently, by imaging methods, the diagnosis of twin pregnancy was established, with a hydatidiform mole and a coexisting live fetus. The ultrasound revealed a live fetus, 11.3 weeks old, with a hydatidiform mole. What was observed was corroborated on magnetic resonance imaging and the molar pregnancy was delimited. Methotrexate was applied and manual vacuum aspiration was performed. Histopathology analysis confirmed the diagnosis. Weekly monitoring of the free beta fraction of human chorionic gonadotropin (β-hCG) was carried out until the symptoms had completely disappeared. CONCLUSIONS: Since this pregnancy anomaly is extremely rare, the patient must be cared for by a multidisciplinary team that integrates the diagnosis and evaluates the best course of action to follow and prevent the various possible complications. Uterine aspiration is the safest approach for patients with risk factors for gestational trophoblastic neoplasia.

Resumen ANTECEDENTES: La incidencia de embarazos gemelares con mola hidatiforme es de 1 caso en 20,000 a 100,000 gestaciones. La mola hidatiforme completa se origina de un óvulo vacío, sin material genético materno fecundado por un espermatozoide, que duplica su material genético. En el ultrasonido se observa un patrón en “copos de nieve”. Existen dos tipos de atención: conducta expectante o interrupción del embarazo, en ambas situaciones con previa valoración de los riesgos maternos potenciales. Cualquier decisión debe tomarse en conjunto con la paciente y el obstetra. CASO CLÍNICO: Paciente de 43 años, en quien se efectuaron técnicas de reproducción asistida para lograr el embarazo, el conseguido fue: gemelar, bicorial y biamniótico. Posteriormente, por métodos de imagen, se estableció el diagnóstico de embarazo gemelar, con mola hidatiforme y feto vivo coexistente. En el ultrasonido se observó un feto vivo, de 11.3 semanas y mola hidatiforme. Lo observado se corroboró en la resonancia magnética y se delimitó el embarazo molar. Se aplicó metotrexato y se efectuó la aspiración manual endouterina. El análisis de histopatología corroboró el diagnóstico. Se llevó a cabo el seguimiento semanal de la fracción beta libre de la gonadotropina coriónica humana (β-GCh) hasta la desaparición completa del cuadro. CONCLUSIONES: Puesto que esta anomalía del embarazo es sumamente rara, las pacientes deben ser atendidas por un equipo multidisciplinario que integre el diagnóstico y valore la mejor conducta a seguir y prevenir las diversas complicaciones posibles. La aspiración uterina es la conducta más segura para las pacientes con factores de riesgo de neoplasia trofoblástica gestacional.