hydatidiform mole (HM)

invasive mole (IM)

Choriocarcinoma (CH)

Placental-site trophoblastic tumor (PSTT,)

Gestational trophoblastic disease:it ia aspectrum of diseases arises from abnormal fertilization event leading to an abnormal pregnancy

Eitiology,risk factor,epidemiology

1.It is higher in asian&african women .

2.It is higher with maternal age

3.The risk of having second molar higher

4.Diet may play arole

5.Blood group

6.Low estrogen state

Complete mole

Duplication 46XXEmpty ovum

vesicle filling &distending the uterine cavity sometime it develop in the

tubes or the overies ,the fetus &amnion are absent ,carry 20-30%risk

of persistant disease

Histology:hydropic villi,absence of blood vessle, hyperplasia of

trophoblastic epithelium

Partial mole

• Normal ovum

69XXY23X 2323X

23X

Y2323X

partial

• partial hydatidiform mole with evidence of a conceptus but died in 8-9 weeks ,focal trophoblastic hyperplasia at the implantation site, the villi are present ,risk of persistantdisease <5

sign&symptoms1. vaginal bleeding :in the 1st &the beginning of nd trimester n>90% of patients

2.abno rmally enlarged and soft uterus in about half the cases, the uterus growth is rapid, it is larger than the dates

• 3.ovarian cyst

• when we do pelvic examination adnexalmasses may be found. it is theca lutein cyst in about one third of the cases

• 4.Anemia :dilutional or due to hemorrhage

5.severe and early –onset PIH (Pregnancy Induced Hypertension syndrome)

6. hyperthyroidism

plasma thyroxin concentration elevates

7. exaggerated early pregnancy symptoms

nausea, vomit etc

8. Expulsion of the product vaginally

9. No fetal part with _ve fetal heart tone

Diagnosis:

History

Clinical examination

investigation

Ultrasound examination

Serum hCG levels

Chest x_ray

Histopathological examination

B_HCG:its higher than normal pregnency values &can be detected in the serum or urine of all patients (its level correlate with the number of viable

tumour cells).

Ultrasonography:diagnosis of choice reveal snowstorm appearance

• 1.Once the diagnosis is made evacuation of the uterus by suction curettage should be done but prior to that:

hCG preevacuation.

Chest x-ray.

Correct: anemia, toxemia, hyperthyroidism, pulmonary compromise

Treatment

total abdominal

hysterectomy

in older multiparas

hysterectomy may

be indicated.

• 3-medical induction is not recommended because fear of showering emboli through blood stream .

• 4-hysterotomy is not recommended

• All RH _ ve should receive anti _D

Complication

1-perforation2-hemorrhage3-deportation of trophoplastic tissue to the lung is

frequent which may regress spontanously but sometime post evacuation acute pulmonary insufficiency may result leading to dyspnea,cynosis4-6hour after evacuation

4-pulmonary odema from high out put heart failure,PE,anemia,hyperthyrodism

5-sepsis

Surveillance following molar pregnancy

• Following evacuation B-HCG titer should be estimated serially as 20-30%has risk of persistant disease

• The determination should be started at 48h after evacuation &weekly until it become undetectable <5ml/u

• _effective contaceptive measure is essential• The titer remission should occure spontanously by 12-14 weeks

then the pt. should be followed up for 12 months before the pt. is released from Close medical supervision

• -Gynecological exam.1week after evacuation for uterine size ,adenexial mass ,vulval &vaginal deposit (metastasis).&should repeated during the period of survellance

• _1year after –ve titer pregnancy allowed &complication are similar to those of general population

When we give chemotherapy after evacuation

1.Rising or plateau titer during follow up2.High titer after 15th weeks 3.Presence of histological diagnosis of choriocarcinoma4.Metastasis5.Delay post evacuation hemorrhage

• It occure in 20%of patients with H.mole

• Pathologically it is the same as H.mole but pentrate deeply into the myometrium or the adjacent structures leading to uterine rupture &haemoperitoneum.

• It may regress spontanously

Invasive mole

Malignant GTN

• The malignant GTN can be classified into :• The non_metastatic :invasive mole• &• The metastatic :choriocarcinoma and the placental site

trophoblastic tumour(PSTT)• Malignant disease can be suspected when • 1:plateauing or rising B_hCG value over aperiord of 3

consecutive weeks• 2:A rise of B_hCG over aperiord of 2 weeks • 3:Persistence of a detectable B_hCG after 6months of

evacuation

H mole