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Jocson, MD
Gestational Trophoblastic Disease (GTD )
A gp. of Pregnancy –
related Diseases char.
by abnormal
trophoblastic
proliferation
➢ 3 types of Trophoblasts
- Cytotrophoblasts
- Syncytiotrophoblasts
- Intermediate
Trophoblasts Cytotrophoblasts
I. Molar Lesions
A. Hydatidiform Mole –
1. Complete Mole
2. Partial Mole
B. Invasive Mole
II. Non-molar Lesions
A. Choriocarcinoma
B. Placental Site Trophoblastic Tumour ( PSTT)
C. Epithelioid Trophoblastic Tumour (ETT)
D. Misc Trophoblastic Lesions
1. Exaggerated Placental Site
2.Placental Site Nodule
D. Misc. Trophoblastic Lesions
1. Exaggerated Placental Site:
also known as Syncytial Endometritis
presents with
• Grape-like vesicles
• Trophoblastic
hyperplasia
Types of Hydatidiform Mole
• Presence of embryo/fetus
or fetal membrane
Partial Mole: Characteristics
Risk factors:
• Clinical manifestations
• bHCG titer:
single determination is sufficient if –
1,000,000 mIU/ ml at any time
>320,000 mIU/ml after 100 days AOG
Romero,et al, Obstet Gyne 1985
Ultrasound Features:
• “ Snow-Storm Pattern”-
Echogenic uterine mass w/
numerous anechoic cystic
spaces but w/out a fetus or
amnionic sac
Partial Mole
Ultrasound features:
Grossly - Large
edematous
villi ( cluster
of grapes )
Complete Mole:
Microscopic findings:
▪ Edematous
chorionic villi
Trophoblastic
hyperplasia
(cytotrophoblasts,syncytio-
trophoblasts, intermediate
trophoblasts)
W/ cytologic atypia
Partial Mole
Grossly:
Embryo/fetus or fetal
membrane present
Partial Mole :
Microscopic findings:
Mixture of edematous
and normal-sized villi
Trophoblastic proliferation
Irregular scalloping
outline
Presence of blood vessels
Hydatidiform Mole: Diagnosis
Histological Immunostaining to identify the presence of :
▪ Suction curettage –
recommended for those
desirous of future pregnancy
▪ Hysterectomy w/ mole-in-situ
Partial H. Mole – 1 to 5 %
Risk Factors for Malignant Sequela:
- Administration of Methotrexate or
Actinomycin D
prior to or w/in 2 wks after to evacuation
Outcome:
42% - Pregnancy loss (miscarriage, IUFD)
For those w/ surviving fetus:
60% - Preterm birth
40% - Term birth
• Contraception x 6 yr
Regressing Pattern of serial βHCG Titer
Antecedent Pregnancy:
H. Mole – 50%
Abortion/Ectopic – 25%
Term or preterm pregnancy – 25%
Gestational Trophoblastic Neoplasia
• Invasive Mole
• Choriocarcinoma
• Placental Site Trophoblastic Tumour
• Epitheloid Trophoblastic Tumour
Invasive Mole
An H. mole that
has invaded
into the
uterine wall or
has produced
distant
metastasis
Invasive Mole
Clinical manifestations:
Ultrasound:
❖ An abnormal
uterine wall
Invasive Mole : Diagnosis
➢ Hyperplastic cytotrophoblasts
& syncitiotrophoblasts
w/ villous stroma w/in
the myometrium and/or
in metastatic lesions
Choriocarcinoma
❖ A highly malignant, rapidly metastasizing tumor
Pathology:
Clinical Presentation:
• Abnormal uterine bleeding ( 67%)
t 30,000
i 20,000
t 20,000 15,000 5% 5.5% 5.5%
e
10,000 9,500 9,000 8,500
r 10,000
0
1 2 3 4 5 6 7
# of wks post-molar evacuation
28.5%
40%
Management of GTN:
• Evaluation to search for local disease
& metastases:
Chemotherapy ( primary )
Surgery ( adjunctive )
FIGO – WHO Prognostic Scoring System:
FIGO Score 0 1 2 4
EMA-CO or EMA-CE
PSTT : Management