Gestational Trophoblastic Disease
(GTD)
Kang Yu
Obstetric & Gynecology Hospital of Fudan Universtity
2013-11-26
Objectives
Section I Brief Summary of GTD
Section II Clinical Probation Case I Case II Case III
Section III Bedside-to-Bench (and Back) Trophoblast and cancer Research design example
GTD is…
A group of disorders in which trophoblastic
tissue proliferates abnormally GTD includes:
Benign• Hydatidiform mole
• (complete or incomplete)
Malignant (Gestational Trophoblastic Neoplasia, GTN)
• Invasive mole • Choriocarcinoma• Placental site trophoblastic tumor (PSTT)
GTN is remarkable because…
One of the few malignant disease which can be cured Has very high rates of response to chemotherapy
Has a tumor marker (β- HCG) that is… highly sensitive and 100% specific (normal pregnancy excluded)
Song Hongzhao (1915 - 2000 )
In 1994 was elected to the Chinese Academy of Engineering (Department of health)
In 1996 was elected an honorary fellow of British (London) the Royal College of obstetricians
Reduced the mortality rate of 从horiocarcinoma from more than 90% to less than 15%
KEY TERMS AND DEFINITIONS
Hydatidiform Mole. A placental abnormality involving swollen placental villi and
trophoblastic hyperplasia with loss of fetal blood vessels. There are two types: complete and partial.
Complete Mole. A molar pregnancy with swelling of all placental villi. Fetal
tissues are absent.
Partial Mole. A molar pregnancy with some normal and some swollen villi
plus fetal, cord, and/or amniotic membrane elements.
KEY TERMS AND DEFINITIONS
Invasive Mole. A variant of hydatidiform mole in which the hydropic villi
invade the myometrium or blood vessels. It may spread to extrauterine sites.
Choriocarcinoma. A morphologic term applied to a highly malignant type of
trophoblastic neoplasia in which both the cytotrophoblast and syncytiotrophoblast grow in a malignant fashion.
PSTT. A rare type of GTD arising in the uterus that secretes
human placental lactogen (hPL) and human chorionic gonadotrophin (HCG).
Complete mole
Partial mole
Section II Clinical Probation
Case I
Case II
Case III
Section III Bedside-to-Bench (and
Back)
Trophoblast and cancer
Research design example
Trophoblast invasion
A successful pregnancy requires
cytotrophoblasts invade the uterus,
inclusive of its blood vessels, to establish
efficient fetomaternal exchange of molecules.
BACKGROUD
The role of trophoblasts
Cancer Metastasis
Cancer metastasis is a multi-step process
BACKGROUD
The similarities of trophoblast and cancer
High cell proliferation rate
Lack of cell-contact inhibition
Invasion
Escape from immune detection
Expression of common growth factors, cell adhesion molecules, matrix-digesting enzymes and proto-oncogene
Express functional tumour-associated genes
BACKGROUD
1 、 Why choriocarcinoma can be cured?
Biological properties of specific cancers (‘ seeds’)
PUZZLES
2
Choriocarcinoma Other cancer
Trophoblast
2 、 Why choriocarcinoma readily metastasizes to lung?
PUZZLES
3
The microenvironments of different organs are biologically unique. (‘soil’) Endothelial cells in the vasculature of different organs express different cell-surface receptors and growth factors
Organ-specific
Trophoblast invasion
Abortion
IUGR
Normal
pregnancy
Placenta implants
ExcessiveInadequate Adequate
3 、 How trophoblast turn into choriocarcinama?
Choriocarcinoma
Invasiveness gradually reduced
ProliferationInvasion matastasis
Trophoblast invasion Trophoblast invasion
Normal
pregnancy
Adequate
Trophoblast invasion Strictly regulatedHighly controlled Trophoblast invasion
Normal
pregnancy
Adequate
Trophoblast invasion Trophoblast invasion Trophoblast invasion
Excessive
Choriocarcinoma
Trophoblast invasion
Normal
pregnancy
Adequate
Trophoblast invasion
Regulatory factorsOut of control