Gestational Trophoblastic Gestational Trophoblastic Disease (GTD)Disease (GTD)

Types of GTDTypes of GTD

BenignBenign• Hydatidiform mole/molar Hydatidiform mole/molar

pregnancy (complete or pregnancy (complete or incomplete)incomplete)

malignantmalignant• Invasive mole Invasive mole • Choriocarcinoma Choriocarcinoma

(chorioepithelioma)(chorioepithelioma)

The term The term Gestational Trophoblastic Gestational Trophoblastic Tumors Tumors has been applied the latter has been applied the latter three conditionsthree conditions

Arise from the trophoblastic Arise from the trophoblastic elementselements

Retain the invasive tendencies of Retain the invasive tendencies of the normal placenta or metastasisthe normal placenta or metastasis

Keep secretion of the human Keep secretion of the human chorionic gonadotropin (hCG)chorionic gonadotropin (hCG)

Types of GTDTypes of GTD

Hydatidiform MoleHydatidiform Mole (molar pregnancy) (molar pregnancy)

Definition and Etiology Definition and Etiology Hydatidiform mole is a pregnancy Hydatidiform mole is a pregnancy

characterized by vesicular swelling characterized by vesicular swelling of placental villi and usually the of placental villi and usually the absence of an intact fetus.absence of an intact fetus.

The etiology of hydatidiform mole The etiology of hydatidiform mole remains unclear, but it appears to remains unclear, but it appears to be due to abnormal gametogenesis be due to abnormal gametogenesis and fertilization and fertilization

In a In a ‘‘complete molecomplete mole’’ the mass of the mass of tissue is completely made up of tissue is completely made up of abnormal cells abnormal cells

There is no fetus and nothing can There is no fetus and nothing can be found at the time of the first be found at the time of the first scan. scan.

Definition and Etiology Definition and Etiology

In a In a ‘‘partial molepartial mole’’, the mass may , the mass may contain both these abnormal cells contain both these abnormal cells and often a fetus that has severe and often a fetus that has severe defects. defects.

In this case the fetus will be In this case the fetus will be consumed ( destroyed) by the consumed ( destroyed) by the growing abnormal mass very growing abnormal mass very quickly.quickly. (shrink)(shrink)

Definition and Etiology Definition and Etiology

Incidence Incidence

• 1 out of 1500-2000 pregnancies 1 out of 1500-2000 pregnancies in the U.S. and Europein the U.S. and Europe

• 1 out of 500-600 (another report 1 out of 500-600 (another report 1%) pregnancies in some Asian 1%) pregnancies in some Asian countries. countries.

• Complete > incompleteComplete > incomplete

Repeat hydatidiform moles occure Repeat hydatidiform moles occure in 0.5-2.6% of patients, and these in 0.5-2.6% of patients, and these patiens have a subsequent patiens have a subsequent greater risk of developing greater risk of developing invasive mole or choriocarcinomainvasive mole or choriocarcinoma

There is an increased risk of There is an increased risk of molar pregnancy for women over molar pregnancy for women over the age 40the age 40

Incidence Incidence

Approximately 10-17% of Approximately 10-17% of hydatidiform moles will result in hydatidiform moles will result in invasive moleinvasive mole

Approximately 2-3% of Approximately 2-3% of hydatidiform moles progress to hydatidiform moles progress to choriocarcinoma ( most of them choriocarcinoma ( most of them are curable) are curable)

Incidence Incidence

Not definitely benign disease , Not definitely benign disease , has a tight relationship with GTThas a tight relationship with GTT

The microscopic appearance of hydatidiform mole:

•Hyperplasia of trophobasitc cells

•Hydropic swelling of all villi

•Vessles are usually absent

Signs and Symptoms of Signs and Symptoms of Complete Hydatidiform MoleComplete Hydatidiform Mole

• Vaginal bleedingVaginal bleeding• Hyperemesis ( severe vomit)Hyperemesis ( severe vomit)• Size inconsistent with gestational Size inconsistent with gestational

age( with no fetal heart beating age( with no fetal heart beating and fetal movement)and fetal movement)

• PreeclampsiaPreeclampsia• Theca lutein ovarian cystsTheca lutein ovarian cysts

Signs and Symptoms of Partial Signs and Symptoms of Partial Hydatidiform MoleHydatidiform Mole

• Vaginal bleedingVaginal bleeding• Absence of fetal heart tonesAbsence of fetal heart tones• Uterine enlargement and Uterine enlargement and

preeclampsia is reported in only preeclampsia is reported in only 3% of patients.3% of patients.

• Theca lutein cysts, hyperemesis Theca lutein cysts, hyperemesis is rare.is rare.

Invasive moleInvasive mole

Definition Definition

This term is applied to a molar This term is applied to a molar pregnancy in which molar villi pregnancy in which molar villi grow into the myometrium or its grow into the myometrium or its blood vessels, and may extend blood vessels, and may extend into the broad ligament and into the broad ligament and metastasize to the lungs, the metastasize to the lungs, the vagina or the vulva. vagina or the vulva.

Common Sites for Metastatic Common Sites for Metastatic Gestational Trophoblastic TumorsGestational Trophoblastic Tumors

Site Site Per centPer cent

Lung Lung 60-9560-95

Vagina Vagina 40-5040-50

Vulva/cervixVulva/cervix 10-1510-15

Brain Brain 5-155-15

Liver Liver 5-155-15

Kidney Kidney 0-50-5

Spleen Spleen 0-50-5

Gastrointestinal Gastrointestinal 0-50-5

Choriocarcinoma Choriocarcinoma

Definition Definition

A malignant form of GTD A malignant form of GTD which can develop from a which can develop from a hydatidiform mole or from hydatidiform mole or from placental trophoblast cells placental trophoblast cells associated with a healthy associated with a healthy fetus ,an abortion or an ectopic fetus ,an abortion or an ectopic pregnancy.pregnancy.

Characterized by abnormal Characterized by abnormal trophoblastic hyperplasia and trophoblastic hyperplasia and anaplasia , absence of chorionic anaplasia , absence of chorionic villivilli

Definition Definition