Gestational Trophoblastic Disease (GTD). Department of Obs. & Gyn., First Hospital of Xi ’ an Jiaotong University Gao Shang Feng. Introduction. What is GTD ? It is a rare kind of disease in which abnormal trophoblastic proliferation occurs.
Department of Obs.& Gyn., First Hospital of Xi’an Jiaotong University
Gao Shang Feng
What is GTD ?
hydatidiform therapeutic or
invasion mole choriocarcinoma.
GTT is all GTD except hydatidiform mole.
They has its unique pathologic characteristics and biological behavior.
Even the most malignant case can be cured by chemotherapy.
It is a neoplastic proliferation of the trophoblast in which the terminal villi are transformed into vesicles filled with clear viscid material.
It is divided into two classification
Though it is not known a number of associated factors have been noted:
complete hydatidiform moles
partial hydatidiform mole
Complete moles lack identifiable embryonic or fetal tissues, and the chorionic villi exhibit generalized hydatidiform swelling and diffuse trophoblastic hyperplasia.
we see a mass of vesicles, vary in size, grape-like with stems, blood and clot filling the inter-vesicle space
It are characterized by the following pathologic features :
we see a mass of vesicles, vary in size, grape-like and identifiable embryonic or fetal tissues.
partial hydatidiform mole
complete hydatidiform mole
It has eight of symptoms and physical signs.
because it is a pregnancy.
after a period of amenorrhea (average 12 weeks) may continue intermittently for several weeks---profuse bleeding---anemia and infection.
in about half the cases, the uterus growth is rapid, it is larger than the dates suggest.
when we do pelvic examination adnexal masses may be found. it is theca lutein cyst in about one third of the cases
plasma thyroxin concentration elevates
nausea, vomit etc
an unusually high titer of chorionic gonadotropin, especially after the one-hundredth day of pregnancy, help to confirm the diagnosis of HM.
It is a reliable and sensitive technique for the diagnosis of complete molar pregnancy. Because the chorionic villi exhibit diffuse hydatidiform swelling. Complete moles produce a characteristic vesicular sonographic pattern, usually referred to as a “snowstorm” pattern.
in older multiparas
these tumors should not be excised because they regress after the trophoblastic tissue has been removed.
HM don’t need usually chemotherapy because HM is benign disease.
years after discharge
check, the following
should be addressed
abnormal vaginal bleeding,
signs of metastasis
required for 1-2 years
pelvic examination reveals delayed involution of the uterus, persisting cyst .
intra-abdominal hemorrhage, penetration of the uterus .
Identical to that for choriocarcinoma
ulcerating surface opens into the endometrial cavity (rarely embedded in myometrium)
International staging of WHO may be summarized as follows:
Ⅰ: lesion localized in uterus, no metastasis;
Ⅱ: lesion extends beyond uterus, but still confined to internal genitalias;
Ⅲ: pulmonary lesion
Ⅳ: metastasis to other distant sites.
most often used drugs
chest X-ray film