Gestational Trophoblastic Diseases. DR. SAMAA NAZER Assistant Professor of Obstetrics & Gynecology Jeddah, Saudi Arabia. Content:. Definitions Classifications Etiology of molar pregnancy Histologic classification Difference between complete mole and partial mole
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DR. SAMAA NAZER
Assistant Professor of Obstetrics & Gynecology
Jeddah, Saudi Arabia
Refers to the spectrum of abnormalities of the trophoblast associated with pregnancy and they specifically secret human chorionic gonadotrophin. They are among the rare human tumours that can be cured even in the presence of wide spread dissemination.
Persistent GTT Follow:
There is wide variation in the reported incidence of hydatidiform mole
USA 0.75 to 1.0 per 1000 pregnancy
South East Asia 1.5 to 2.5 times higher
Rate 8 per 1000 pregnancy
The risk increase of subsequent mole by 20 to 40 times
studies show low dietary intake of carotin, folic acid
Deficiency may contribute the development of mole.
Extreme of age below 20 years or older than 40 years (due to defective fertilization)
- lack of embryonic or fetal tissue
- chronic villi exhibit genaralized hydrobic swelling .
- diffuse trophoblastic hyperplasia of the syncytiotrophoblast and cytotrophoblast.
complete mole only paternal chromosome fertilize an empty egg which result in a chromosome of 46xx in 80% of cases
20% of cases the chromosome is 46 xy
where Haploid sperm one x and one Y fertilized empty egg.
Duplication of the paternal chromosome is called adrogenesis
Genetic of partial mole:
They are usually triploid and have 69 chromosomes of both maternal and
paternal origin (69 xxx) (69 xxy). The most common
mechanism of origin is a haploid egg being fertilized
by two sperm.
Another Mechanism is the abnormal diploid sperm
fertilize the haploid egg
They are malignancies that occur after or in association with pregnancy
Other primary site
Choriocarcinoma occurs in about 3% - 5% of molar pregnancy
The rate in United State is 1 per 20,000 pregnancies
After normal pregnancy 1 per 40,000 term pregnancy
It is rare consist of groups of mononucleated and multinucleated trophoblastic cell at the implantation site
Histochemical studies have shown that the cells tend to stain with human placental lactogen (HPL) than for BHCG and both should be monitored.
The treatment is hysterectomy.
1.Abnormal vaginal bleeding in early pregnancy (97%)
2. Lower abdominal pain
Diagnosis of complete mole:
Finding: a. Absence of the fetus
b. Snow storm – like pattern
c. Ovarian enlargement
The level in normal pregnancy reach peak at 10-14 weeks rarely exceed level of 100,000 MIU/ML
Level excess of 100,000 MIU/ML suggest GTD
I – Evaluation of the patient for:
Anemia, hypertension, pulmonary insufficiency,
hyperthyroidism, DIC, by doing:
2. Liver function test (LFT)
3. PT, PTT, fibrinogen
4. Renal function test
5. Thyroid function test (TFT)
6. Blood group Rh
7. Cross match 2 units of blood
8. Chest x-ray
II – Treated by evacuation of the uterus:
Using suction evacuation plus intravenous oxytocin
III – If patient has completed child bearing hysterectomy in high risk patient
The patient should be carefully monitored for the
potential development of malignant sequalae by
serial determination of B-HCG .
The risk of GTT is increased with :
To do metastatic work up by:
1. ½ cases after molar pregnancy
2. ¼ cases after normal pregnancy
3. ¼ cases after abortion, ectopic pregnancy
Stage I : Confined to the corpus
Stage II : Metastasis outside the uterus to vagina,
or pelvic structure
Stage III : Metastasis on the lungs
Stage IV : Distant metastasis
I - Non metastatic GTT
II – Metastatic GTT
1. Disease present less than 4 month
2. Pre treatment B-HCG less than
3. No prior chemotherapy
b. Poor prognosis:
1. Disease present more than 4 months
2. Pre treatment B-HCG greater than40,000 MIU/ml
3. Presence of metastatic to site other than lungs and
vagina, i.e. liver and brain.
4. Failure of prior chemotherapy
Single agent chemotherapy
( Methotrexate )
2. Poor prognosis GTT