Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Gestational Trophoblastic Disease PowerPoint PPT presentation
. DISEASE
? Group of tumors typified by abnormal trophoblast
proliferation
?
Histologically :
1. hydatidiform mole
a) benign complete and partial mole
b) malignant invasive mole
2. non-molar trophoblastic malignant neoplasms
a) choriocarcinoma
b) placental site trophoblastic tumor
c) epithelioid trophoblastic tumor
GESTATIONAL TROPHOBLASTIC
. DISEASE
PREMALIGNANT
GTN/MALIGNANT GT
CONDITIONS
DISEASE/PERSISTENT GT
DISEASE
Complete hydatidiform
Invasive mole
mole
Choriocarcinoma
Partial hydatidiform
Placental site trophoblastic
mole
tumor
Epithelioid trophoblastic
tumor
HYDATIDIFORM MOLE
Classical histological findings of molar pregnancy
include trophoblastic proliferation and villi with
stromal edema
Hydropic degeneration and avascularity of chorionic
villi..
Degree of histological changes,karyotypic
differences,absence or presence of embryonic
elements ... a) complete mole
b) partial mole
GTN frequently follows complete hydatidiform mole
PATHOGENESIS ....
COMPLETE MOLE:
duplication of chromosome of haploid sperm after
meiosis ,following fertilization of inactivated or empty
ovum; 46XX.
androgenesis.
Less commonly chromosomal pattern 46XX and 46XY
may occur due to dispermic fertilization of empty
ovum dispermy.
paternal origin.
Abnormal chorionic villi grossly appear as mass of
clear vesicles.
COMPLETE MOLE
PARTIAL MOLE
PARTIAL MOLE:
triploid( 69XXX or 69XXY);less commonly 69XYY.
2 sets of paternal haploid genes and 1 set of maternal
haploid genes (dispermic fertilization) .This paternal
contribution is called diandry .
Less frequently a similar haploid egg may be fertilzed by an
unreduced diploid 46XY sperm.
Show some fetal tissue,at least an amniotic
sac.
Fetus with features of triploidy or tetraploidy (also seen) ...
IUGR,multiple malformation,dies earier.
FEATURES OF COMPLETE AND PARTIAL HYDATIDIFORM MOLE
FEATURE
COMPLETE MOLE
PARTIAL MOLE
? KARYOTYPE
? 46,XX or -XY
? 69XXX or XXY
? CLINICAL
PRESENTATION
? preliminary diagnosis
? MOLAR GESTATION
? MISSED ABORTION
? uterine size
? 50% LARGE for dates
? SMALL for dates
? theca lutein cysts
? 25-30%
? RARE
? medical
? 10-25%
? RARE
complications
? initial hcg levels
? >100,000 mIU/mL
? <100,000mIU/mL
? rate of subsequent
? 15-20% of cases
? 1-5% of cases
GTN
FEATURES OF COMPLETE AND PARTIAL HYDATIDIFORM MOLE
PATHOLOGY
COMPLETE
PARTIAL MOLE
MOLE
EMBRYO-FETUS
ABSENT
OFTEN PRESENT
AMNION,FETAL
ABSENT
OFTEN PRESENT
RBCs
VILLOUS EDEMA
WIDESPREAD
FOCAL
TROPHOBLASTIC SLIGHT TO
FOCAL,SLIGHT
PROLIFERATION
SEVERE
TO MODERATE
Trophoblast
MARKED
MILD
ATYPIA
P57KIP2
NEGATIVE
POSITIVE
immunostaining
Scalloping of
ABSENT
PRESENT
chorionic villi
Stromal inclusions ABSENT
PRESENT
HISTOLOGY :
Complete mole .....
INCIDENCE AND AETIOLOGY :
Varies with ethnic differences : Asians > Caucasions. (3)
Maximum in orientals like chineese and japaneese
Extremes of age : adolescents and 36-40 years (2)
:>40yrs (10)
Previous mole. : complete mole - .9% risk
-2 prior complete mole -20% have 3rd
: partial mole - .3% risk
? Sporadic ( vast majority)
? Familial syndrome of recurrent hydatidiform mole-rare.
Role of other factors ?less clear.
SYMPTOMS...
Amenorrhea of varying duration
Passage of vesicles per vaginum
Bleeding per vaginum
Nausea and vomiting ...
more pronounced with complete than partial mole
as gestation advances
SIGNS...
Uterus : 50% cases-enlarged; larger than period of
. amenorrhea; softer
:35% corresponds to gestational period
:15% it may be smaller
Fetal heart sounds wont be heard with complete
mole.
Hyperemesis
? Theca lutein cysts felt in ovaries(50%cases) most common
with complete mole
- Larger moles are more likely to develop cysts:
overstimulation of luteal elements by hCG.
- Theca lutein cysts-PT Disease
- regress following evacuation(expectant
management preferred)
.
-rarely undergo torsion, infarction and .
hemorrhage
.
-oophrectomy -extensive infarction after
untwisting .
.
Thyrotoxicosis--thyrotrophic like effect of hCG .
- free T 4 THYROXINE- inc;TSH-decrease
- mimicked by bleeding and sepsis from infected products.
Respiratory distress ?due to embolisation
PARTIAL MOLE may not present with classic features
of a complete mole.
Vaginal bleeding is a usual symptom.
Many a times- incomplete or missed abortion
? Uterine bleeding-
-spotting or profuse hemorrhage
-almost always with untreated molar pregnancy
-may preceed spontaneous molar abortion or
follows an intermittent course for weeks to months
? Fe deficiency anemia ?advanced moles with
concealed uterine hemorrhage
Pre-eclampsia/eclampsia:
- Early onset pre-eclampsia (HTN <20wks ?important to
rule out hydatidiform mole)
- Severe pre-eclampsia/eclampsia-common with
advanced molar pregnancy.....seldom seen today...early
diagnosis evacuation
( exception- normal fetus+complete mole
in continuing twin gestations severe pre-
eclampsia mandates preterm delivery... )
TWIN PREGNANCIES...
Chromosomally normal fetus + complete diploid
molar pregnancy
Single partial molar pregnancy + abnormal fetus
Amniocentesis and fetal karyotyping-
confirmation
Survival of normal fetus depends on associated
comorbidity from molar component...pre-
eclampsia and hemorrhage necessitates preterm
delivery...
This post was last modified on 12 August 2021