GESTATIONAL

TROPHOBLASTIC
DISEASE(GTN)
 DEFINATION
Gestational trophoblastic disease(GTN) refers to a spectrum of
interrelated but histologically distinct tumors originating from the
placenta
characterized by a reliable tumor marker, which is the -subunit of
human chorionic gonadotropin (-hCG), and have varied tendencies
or local invasion and spread.
WHO CLASSIFICATION
MOLAR PREGNANCY
HYDATIDIFORM MOLE
COMPLETE
PARTIAL
INVASIVE MOLE
TROPHOBLASTIC TUMORS
CHORIOCARCINOMA
PLACENTAL SITE TROPHOBLASTIC TUMOR
EPITHELIOID TROPHOBLASTIC TUMOR
COMPLETE HYDATIDIFORM MOLE
THESE MOLAR PREGNANCY DIFFER FROM THE PARTIAL MOLES WITH
REGRADS TO THEIR KAROTYPE, THEIR HISTOLOGICAL APPEARANCE
AND THEIR CLINICAL PRESENTATION.
COMPLETE MOLES TYPICALLY HAVE A DIPLOID KARYOTYPE(85 TO 90
% OF CASES ARE 46XX).
THERE IS ABSENCE OF FETUS OR EMBRYO.
THECA LEUTIN CYSTS ARE COMMON IN COMPLETE MOLE(25 -50%).
THERE IS PRONOUNCED AND DIFFUSE DEGENERATION OF VILLI.
THE UTERINE SIZE LOOKS MORE THAN THE DATE(30-60%).
THE LEVEL OF -hCG IS SIGNIFICANTLY INCREASED.
 PATHOLOGY
IT IS PRINCIPALLY A DISEASE OF THE CHORION.
DEATH OF OVUM OR FAILURE OF EMBRYO TO GROW IS NECESSARY TO
DEVELOP COMPLETE HYDATIDIFORM MOLE.
THE SECRETION FROM THE HYPERPLASTIC CELLS AND TRANSFERRED
SUBSTANCE FROM MATERNAL BLOOD ACCUMULATE IN THE STROMA OF
VILLI.
RESULTS IN DISTENTION OF VILLI TO FORM SMALL VESICLES.
MACROSCOPICALLY:
THE MASS FILLING THE UTERUS IS MADE OF MULTIPLE CHAINS
AND CLUSTERS OF CYST OF VARYING SIZE(GRAPES LIKE VESICLES)
 MICROSCOPICALLY:
THERE IS MARKED PROLIFERATION OF SYNCITIAL AND
CYTOTROPHOBLASTIC EPITHELIUM
MARKED THINING OF STROMAL TISSUE DUE TO HYDROPIC
DEGENERATION.
THERE IS ABSENCE OF BLOOD VESSELS IN THE VILLI.
THE VILLUS PATTERN IS DISTINCTLY MAINTAINED.%