GESTATIONAL TROPHBLASTIC DISEASE

Divided into three categories:Hydatidiform MoleInvasive MoleChoriocarcinoma

All elaborate high titer of human chorionic gonadotropin(hCG) in the blood and urine.

The titer progressively increase from hydatidiform mole to invasive mole to choriocarcinoma.

The change in (hCG) level, fall or rise, aid in the monitoring the effectiveness of the treatment .

HYDATIDIFORM MOLE COMPLETE AND

PARTIALIncidence

1-1.5 /2000 pregnancies in the united states and western countries.

Higher incidence in Far East countries ( 10in1000 in indonesia).

Occur before 20y and after 40y.

Is common complication of gestation.

GESTATIONAL TROPHOBLASTIC DISEASE:

HYDATIDIFORM MOLE, COMPLETE TYPE

Swollen, avascular villi covered by chorionic epithelium (trophoblast) of varying atypia

Gross appearance is that of a voluminous mass of grape like structures

Partial hydatidiform mole

Is developed as the result of fertilization of a normal egg by two spermatozoa.

The chorionic epithelial cells are always triploid (69XXY).

Serum HCG level is less elevated.

Rarely progresses to choriocarcinoma.

GESTATIONAL TROPHOBLASTIC DISEASE: COMPLETE VERSUS PARTIAL HYDATIDIFORM

MOLE

FEATURE COMPLETE PARTIAL

Karyotype 46, XX (rare XY) 69, XXY

Villous edema all villi some villi

Trophoblast Pro- diffuse; circum- partial liferation ferential

Atypia often absent

serum HCG elevated less elevated

HCG in tissue ++++ +

Behavior 2% get chorio- rare chorio-

carcinoma carcinoma

INVASIVE MOLEIt is intermediate between a benign mole and choriocarcinoma.

It is invasive locally but have no metastatic potential.

Invasive mole have edematous villi penetrating the uterine wall deeply causing severe hemorrhage.

CHORIOCARCINOMAIt is an aggressive malignant tumor , arise from the

gestational chorionic epithelium or from totipotential cells within the gonads or elsewhere.

Incidence is 1/30000 pregnancies in the west and USA, more common in Asian and African 1/2000 pregnancies.

Occur at age 20y and after 40y.

50% of choriocarcinoma follow a complete mole

25% arise after abortion

20% occur after normal pregnancy

CHORIOCARCINOMa

CHORIOCARCINOMATreatment:ChemotherapyMaternal immune response against the foreign paternal antigen aids in the effectiveness of treatment.