GESTIONAL TROPHOBLASTIC

NEOPLASIA
 Definition:
o Abnormal placental (trophoblostic) proliferation
o Called molar pregnancy

 Classification

 Etiology
o Ethinic - Asian women living in Asia (up to 1 – 200)
- Low incidence in western European and U.S.A.
 o Very young women and the end of their years
o Dietary folic acid deficiency

 Hydatidiform mole (molar pregnancy)

o Complete hydatidiform mole
- Abnormal proliferation of the syncytiotrophoblost
- Replacement of normal placental by hydropic placental
villi
- Not formation of feto

o Partial moles
- Focal trophoblastic proliferation and degeneration of the
placenta
- Chromosomally abnormal fetus
 Genetic constitutions
o Complete mole
- Paternal origen blighted ovum by a haploid sperm
- Karyotype 46 xx
- Is more common (90%) and malignant transformation is
>
o Partial mole
- Triploidy most common 69 xxy
1 haploid set of maternal chromosome
2 haploid set of paternal chromosome
 Clinical Presentation
o Uterine size/dates discrepancy
o Exaggerated subreactive symptoms of pregnancy
o Bleeding is the most characteristic (painless)
o Passage of edematous throphobost through the dilated cervical os
o Positive pregnancy test
o USG “snowstorm”
o Severe nausea and vomiting
o Pregnancy – induced hypertension (pre – eclampria)
o Proteinuria
o Hyperthyroidism
o Odnexal masses (theca lutein cyst)
o Histological
- Complete mole
- Invasive mole (chorioadenoma destruens) invading the
myometrium
 Clinical presentation parcial molar pregnancy
o Similar to complete mole
o > gestional age (after 20th week)
o Uterine growth less than expected
o Hypertension
o Abnormal fetus

 Laboratory assessmant
o Level of HCG classify risk
sensitive tumor marker (follow – up)
o Chest – x ray
o HTO, HB, blood type
o Proteinuria
o Hyperthyroidism
 Treatment
o Removal of the intrauterine contents
o Dilatation of cervix, followed by suction curettage
o Gentle sharp curettage (small amount of myometrical tissue)
o Large mole Atony uterine blood loss oxytocin
blood
o Partial mole: > 24 week induction labor prostaglandin
vaginal
- Associated trophoblostic emboli
- TTO pregnancy – induce hypertension
o Older reproductive age histerectomy (high risk)
o Bilaterally multicystic ovaries (theca Lutein cyst) do not
requere surgical removal.
 High – Risk

 Postevacuation management
o Followed closely for at least 1 year
o Sharp curettage determinin myometrial invasion
o Rhogam incomplete mole
 Metastatic/malignant gestional trophoblastic
neoplasia
o Malignant transformation hydatidiform mole
choriocarcinoma
o Myometrial and uterine vassel invasion
o Metastasis hematogenous embolization
o Lung, vagina, SNC, kidney, liver
o May also follow normal term pregnancy, abortion or ectopic
pregnancy
1 150.000 pregnancies
1 15.000 abortions
2 5.000 ectopic
1 40 mola
 Non mestastatic persistent GNT single agent
chemotherapy