Hydatidiform Hydatidiform MoleMole

Mamdoh Eskandar Mamdoh Eskandar FRCSCFRCSC

Gestational trophoblastic Gestational trophoblastic DiseaseDisease

Molar pregnancyMolar pregnancy-Complete hydatiditform mole-Complete hydatiditform mole

-Incomplete hydatiditform mole-Incomplete hydatiditform mole ChoriocarcinomaChoriocarcinoma Placental-site trophoblastic Placental-site trophoblastic

tumortumor

Molar PregnancyMolar Pregnancy Complete moleComplete mole- Fertilization an empty - Fertilization an empty

egg by one sperm.egg by one sperm.

-All placental villa -All placental villa swollen.swollen.

-Fetus, cord, amniotic -Fetus, cord, amniotic membrane are absent.membrane are absent.

-Paternal chromosomes -Paternal chromosomes only. 46 XX.only. 46 XX.

-diploidy-diploidy

Incomplete moleIncomplete mole--fertilization of an egg by fertilization of an egg by

two spermstwo sperms-some placental villa -some placental villa

swollenswollen- Fetus, cord, amniotic Fetus, cord, amniotic

membrane are membrane are presentpresent

- Paternal and Paternal and maternalmaternal

69XXY69XXY--TriploidTriploid

Molar PregnancyMolar Pregnancy Incidence and epidemiology:Incidence and epidemiology:-In USA 1:1000-In USA 1:1000-In Asia 8:1000-In Asia 8:1000 Risk factors for molar pregnancy:Risk factors for molar pregnancy:-Extreme of age-Extreme of age-Lower socioeconomic status-Lower socioeconomic status-Race and ethnic origin-Race and ethnic origin-Blacks have lower incidence-Blacks have lower incidence

Molar PregnancyMolar Pregnancy Symptoms and signs of molar Symptoms and signs of molar

pregnancypregnancy

-Abnormal bleeding in early -Abnormal bleeding in early pregnancypregnancy

-Lower abdominal pain-Lower abdominal pain

-Toxemia before 24 weeks of gestation-Toxemia before 24 weeks of gestation

-hyperemesis gravidarum-hyperemesis gravidarum

Molar PregnancyMolar Pregnancy-Uterus large for dates-Uterus large for dates

-No fetal heart rate-No fetal heart rate

-Enlargement of the ovaries -Enlargement of the ovaries

-Hyperthyroidism-Hyperthyroidism

-Expulsion of swollen villi-Expulsion of swollen villi

Molar PregnancyMolar Pregnancy Diagnosis:Diagnosis:--UltrasoundUltrasound shows snowstorm-like shows snowstorm-like

appearance, no fetus, theca lutein cystappearance, no fetus, theca lutein cyst

--Beta hCGBeta hCG in normal pregnancy the level is in normal pregnancy the level is at it peak at around 14 weeks (100,000 at it peak at around 14 weeks (100,000 mIU/ml)mIU/ml)

TORONTO, CANADA, 1998, SANT.JOS. HOS.

ManagementManagement Once the diagnosis is made Once the diagnosis is made

evacuation evacuation of the uterus should of the uterus should be done but prior to that:be done but prior to that:

hCG preevacuation.hCG preevacuation.

Chest x-ray.Chest x-ray.

Correct: anemia, toxemia, Correct: anemia, toxemia, hyperthyroidism, pulmonary hyperthyroidism, pulmonary compromise.compromise.

Follow upFollow up HCG weekly until normal for two HCG weekly until normal for two

values then monthly for one year.values then monthly for one year. Repeat x- ray if HCG rises or Repeat x- ray if HCG rises or

plateau.plateau. Contraception for one year.Contraception for one year. Pelvic examination every 3 weeks for Pelvic examination every 3 weeks for

3 months.3 months.

Follow upFollow up Initiate chemotherapy if:Initiate chemotherapy if:-HCG level is increasing or plateaus-HCG level is increasing or plateaus

-Metastasis disease is present-Metastasis disease is present

-HCG level is still elevated after 6 -HCG level is still elevated after 6 months of evacuationmonths of evacuation

-HCG starts to rise after being -HCG starts to rise after being undetectableundetectable

FICO Classification System FICO Classification System of GTTof GTT

I. Confined to corpus uteriI. Confined to corpus uteri

II. Metastases to vagina or II. Metastases to vagina or pelvic organspelvic organs

III. Metastases to lungsIII. Metastases to lungs

IV. Distant metastasesIV. Distant metastases

Prognostic Prognostic Classification of GTTClassification of GTT I. Nonmetastatic GTTI. Nonmetastatic GTT II. Metastatic GTT: disease outside the II. Metastatic GTT: disease outside the

uterus.uterus.A.A. Good prognosis:Good prognosis:1.1. Disease present less than 4 monthsDisease present less than 4 months2.2. Pretreatment HCG is less than 40,000Pretreatment HCG is less than 40,0003.3. No prior chemothreapy No prior chemothreapy 4.4. No metastatic to the liver or the brainNo metastatic to the liver or the brainB.B. Poor prognosis:Poor prognosis: the opposite of good prognosisthe opposite of good prognosis

Thank you!