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GESTATIONAL
TROPHOBLASTIC DISEASE
MALIGNANT GESTATIONAL
PREMALIGNANT
NEOPLASIA
CONDITIONS
1.PARTIAL
VILLOUS
INTERMEDIATE TROPHOBLAST
MOLE
TROPHOBLAST
2.COMPLETE
PLACENTAL SITE TROPHOBLASTIC
MOLE
1.INVASIVE MOLE
TUMOUR
(PSTT)
2.CHORIOCARCINOMA
EPITHELIOID TROPHOBLASTIC
TUMOUR
#MALIGNANTGESTATIONALTROPHOBLASTIC
DISEASEorPERSITENTGESTATIONAL
TROPHOBLASTICDISEASE
Incidence is about 1 in 5000
pregnancies in oriental countries
50%-molar pregnancy
25% after abortion and ectopic
pregnancy and a few after normal
pregnancy
Non metastatic (locally invasive}lesions
-15%
Metastatic lesions -4% after molar
evacuation
INVASIVE
MOLES(80%)
POSTMOLAR
PREGNANCY
CHORIOCARCI
GTN
NOMAS(20%)
NON MOLAR
Almost always a
PREGNANCY
CHORIOCARCI
NOMA
Persistent GTN is evidenced by the persistance of
trophoblastic activity following evacuation of
molar pregnancy
1
2
3
After molar evacuation beta Hcg
become normal in about 7-9 weeks.
GTN should be suspected in a women of
reproductive age group presenting with
metastatic disease from an unknown primary
invasive mole
.
CHORIADENOMA DESTRUENS
EXTENSIVE TISSUE INVASION BY
TROPHOBLAST AND WHOLE VILLI
PENETRATION IS DEEP INTO
MYOMETRIUMSOMETIMES WITH THE
INVOLVMENT OF THE PERITONEUM
ADJACENT PARAMETRIUM OR VAGINAL
VAULT.
DIAGNOSIS
*
CHORIOCARCINOMA
Carcinoma of the CHORIONIC
EPITHELIUM
Follows term pregnancy or miscarriage.
Only third of cases follow a molar gestation
Choriocarcinoma are commonly accompanied
by ovarian theca-lutein cysts.
PRIMARY SITE ANYWHERE IN UTERUS
RARLEY- IN OVARY OR TUBE
GROSS
MICROSCOPY
HISTORYOFMOLARPREGNANCY/TERM
PREGNANCY/ABORTION/ECTOPICPREGNANCY
A
hbenSyaomltrmhaluterinebleeding,Persitentill
ptomspertain gtometastasielsewher
1.Hemoptysi(lung-75%)
2
h.Feadtaurcheso,cfInvtraulsicroan.ciaolsmpaaceocupyinglesion-
3.Vaginalmetastasi(50%)
4.Metastasialsocurto
Vulva-iregularandat imesbriskhemorhage
Liver?epigastricpain,jaundice
Signs-patientlooksill,pallorofvaryingdegre
BIMANUAL
1.CHEST XRAY
EXAMINATION
2.PELVIC
SUBINVOLUTION
SONOGRAPHY(to
OF UTERUS
differentiate from
normal pregnancy
PURPLISH RED
3.DIAGNOSTIC
NODULES IN THE
UTERINE CURETTAGE
LOWER THIRD OF
ANTERIOR
4EXCISION BIOPSY OF
VAGINAL WALL
VAGINAL NODULES
5.CT SCAN OR MRI OF
BRAINL,LIVER
Histopathological diagnosis
on doing curettage for
irregular bleeding.
Rapidly increasing levels of
serum beta hcg.
1.Chest x ray showing widespread metastatic lesions
2.Autopsy specimen with multiple hemorragic hepatic metastasis
PLACENTAL SITE TROPHOBLASTIC
TUMOUR
Incidence-
15-20% OF
<1% of
PATIENTS
COMPOSED MAINLY OF
patients with
DEVELOP
GTN
METASTASIS
*TREATMENT by hystrectomy is
preferred.
(locally invasive tumours are
ressistant to hystrectomy)
*For higher risk stage 1 and later
stages,adjuvant multidrug
chemotherapy is given.
*Arise from
Primary treatment is hysterectomy because
this tumor is relatively resistant to
chemotherapy.
Metastatic disease is common, and
combination chemotherapy is employed
BETA
BIOPSY IS NOT
HCG
USUALLY
REQUIRED
SCORE
0
1
2
4
AGE
<40
> or =to
-
-
40
ANTICEDENT
MOLE
Abortion
Term
-
PREGNANCY
Interval after index
<4
4-6
7-12
>12
pregnancy(mo)
Pretreatment serum beta <1000
1000-
10000- >or
hcg(mIU /mL)
10,000
10000 =to100000
0
Largest tumor
<3cm
3-4cm
>or=5 -
size(including uterus)
cm
Site of metastasis
-
Spleen,
GI
Liver, brain
kidney
Number of metastasis
-
1-4
5-8
8
Previous failed
-
-
1
> or=2
chemotherapy drugs
STAGE 1
DISEASE CONFINED TO THE UTERUS
STAGE 2
GTN EXTENDS OUTSIDE THE UTERUS BUT
LIMITED TO THE GENITAL STRUCTURES
(ADENEXA,VAGINA,BROAD LIGAMENT)
STAGE 3
GTN EXTENDS TO THE LUNGS WITH OR
WITHOUT GENITALTRACT INVOLVMENT
STAGE 4
ALL OTHER METASTATIC SITES
This post was last modified on 12 August 2021