GESTATIONAL TROPHOBLASTIC
DISEASES
Presenter:
Dr. Macharia
(MBChB).
For:
Dr. Juma
(Senior Consultant, OBGYN)
• OUTLINE
1. Definition
2. Classification
3. Pathology and pathogenesis
4. Clinical features
5. Investigations and treatment options
6. Prognosis and the future
introduction
• Gestational trophoblastic disease refers to a
spectrum of pregnancy-related trophoblastic
proliferative abnormalities.
• Zygote…morula….blastocyst……inner cell
mass, outer cell mass (Trophoblast)
syncitiotrophoblast... Cytotrophoblast
classification
1.Pathological
2.Clinical
classification
Pathological
1. Hydatiform moles............................90%
2. Invasive mole....................................5%
3. Choriocarcinoma.............................2-3%
4. Placenta site trophoblastic disease....1%
5. Epitheloid trophoblastic tumour.......1%
classification
Clinical
BENIGN
1. Hydatiform moles............................90%
MALIGNANT
1. Invasive mole....................................5%
2. Choriocarcinoma.............................2-3%
3. Placenta site trophoblastic disease....1%
4. Epitheloid trophoblastic tumour.......1%
• All these tumours arise from the trophoblastic
cells
• Exception PSTD arise from intermediate
trophoblastic cells
• Retain properties of the placenta
• They all secrete Beta HCG important for
diagnosis n follow up
Hydatidiform mole
• A pregnancy characterised by vesicular swelling
of placenta villi and usually the absence of an
intact fetus
• Also called molar pregnancy
• Etiology unclear...appears to result from
abnormal gametogenesis and fertilisation
• Can be complete or partial
H. mole
• Prevalence
• Hydatidiform Mole is the commonest of these
diseases.
• 10* more in the east 1:5000 ppn
• In Taiwan the incidence is 1:125 deliveries
• USA 1:1500 deliveries
• Kenya 1:370 deliveries. Home deliveries
• The incidence of choriocarcinoma in Kenya is 1:
847
H mole...
Risk factors.
• Age <16 N >40yrs.
• History of molar pregnancy
• Certain HLA types,
• A +O ....AB POOR PROGNOSIS.
• Nutrional deficiencies: proteins, FolicAcid,
Vitamin A
• Multiparity
• Low SES
H mole
TYPES
• Complete . No embryo. Anucleate ovum.
• Partial....discernible fetal parts ..usually triploid
(69 chromosomes)
• ASSIGNMENT list 5 differences between a
partial and a complete mole
Pathology
• multiple grapelike vesicles filling and distending
the uterus
• There is edema of the villi stroma, avascular
villi,nests of proliferating synciotrophoblast and
cytotrophoblast elements surrounding the villi.
• The likely hood of malignant transformation
depends on degree of proliferation and
anaplasia
Molar pregnancy
Clinical features
• A period of amenorrhoea
• 90% present with pv bleeding
• 80% present with passage of vesicles
• 14.3% present with hyperemesis
• PET 10-12%
• Hyperthyroidism 10%
• Multiple ovarian cysts 15-30%
• FH>DATES, absent Fetal parts on palpation
Molar pregnancy
Diagnostic tests
• PDT. Positive in high dilution.
• Beta HCG*10 of what is expected for gestation
• FBC, LFTs,ESR
• Radiography....honey comb appearance
• CXR
• Ultra sound: snow storm appearance
H mole: management
• Suction evacuation of the uterus under high
dose syntocinon. 80% are curable after D&C
• Hysterectomy if uncontrollable hemorrhage
• GXM at the ready!!!!!!!
• Follow up with serum b HCG 2/52 for 3/12
• Then monthly for 9 months. Some – 3
months for 1 more year.
• GIVE OC…no AUBs
H mole
SEQUELAE
• 25% invasive mole
• 3-5% chorioca
• 70% no change
• COMPLICATIONS Haemorrhage, PET,HG
CHORIOCARCINOMA
•
•
•
•
highly malignant metastasises rapidly
50% follow Hmole
25% follow abotions
25% follow term pregnancy
• BIOPSY IS Contraindicated.
a) Highly vascularised
b) Highly metastatic
clinical features dx
• As above POA
• IN additional metastasis hemoptysis, icp,
haemorhagic diasthesis, pv bleeding
• Dx as above
• RX M MAC, EMACO
• Radiation
• Combination
• Surgery..hysterectomy if desired family size
Invasive mole
• A histological diagnosis.. after hysterectomy
• Rx as chorioca
PSTD
•
•
•
•
•
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1% of GTDS
From IT.
Human placenta lactogen for diagnosis
Metastasis. Less aggressive
POOR response to chemo
Definitive rx surgery
summary
GTDs are proliferative diseases of the
trophoblasts
With good Hx PE and Ix.. Clinicians can easily
pick GTDs
GTDs are very treatable upon establishing
diagnosis
Thank
listening
you
for