3. Outline
 DEFINITION
 CLASSIFICATION
 INCIDENCE
 RISK FACTORS AND EITIOLGY
 CLINICAL PRESENTATION
 LABORATORY FINDINGS
 IMAGING
 TREATMENT
 FOLLOW UP
 PROGNOSIS
 REVIEW

4. Definition:, Neoplastic proliferation of placental tissue.
GTN is an abnormal proliferation of
placental tissue involving both
cytotrophoblasts and syncytiotrophoblasts,
 it can be either benign or malignan .
It is a disease of early pregnancy occuring
mostly before the 16 weeks of gestation like
ectopic pregnancy and miscarriage.

5. Classification of GTN
1. Benign gTn
 Complete mole
 Incomplete mole
2. Malignant GTN
 Invasive mole
 Choriocarcinoma

6. Benign (Hydatidiform mole)
It is characterized histologically by cystic
swelling of choronic villi accompanied by
variable amount of trophoblastic proliferation.
Have increased risk of invasive mole and
choriocarinoma
Currently diagnosed at early age b/c of USG
and close monitoring of early pregnancy.
Occurs at extremes of reproductive ages.
More common in eastern world (Asia)

7. 2 types of hydatidiform mole
Genetically either two sperms fertilize
an empty ovum or one sperm
duplicates / 46xx

8. Complete mole GTN
Complete mole is the most common benign GTN
which result from fertilization of an empty egg with a
sigle x sperm resulting paternaly derived 46,xx
karyotype.
No fetus,umblical cord and amniotic fluid is seen.
The uterus is filled with grape like vesicles composed
of edematous avascular villi.
Progression to malignancy is 20%.
Beta HCg very high.

9. Excessive vomiting AND nausea
Pregnancy with bleeding
Large for dates uterus
U/S – no fetus
fetal heart sound absent
Increased B – HCG levels
Snow strom appearance on USG
CLINICAL PRESENTION
WITH
LAB AND USG

10. Incomplete or partial mole
Triploid – 2 sets of paternal and
one set of maternal
chromosomes

11. PRESENATION
Patient presents with pregnancy and irregular
vaginal bleeding
U/S – Embryo with molar changes in placenta
Early fetal death

12. Comparison b/w complete
&partial mole

13. CHORIOCARCINOMA
It is malignant neoplasm of
trophoblastic cells derived from a
previously normal or abnormal
pregnancy.
Rapidly invasive and
metastasizes widely.
Good response to chemotherapy
in comparison to choriocarcioma
arising in ovary from germ cell.

14. CHORIOCARCINOMA
1/20,000 t0 30,000 preg in US in AF 1/2500
50 % follow CM
25 % Non molar abortion
25 % term pregnancy
1/40 hydatidiform mole >>choriocarcinoma.
1/150,000 normal pregnancies.
Patients present with irregular or heavy vaginal
bleeding or symptoms due to Metastasis to brain, lung ,
liver.

15. Malignant GTN and prognosis
 This is the gestational trophoblastic tumor
which can develop into three categories,
1. Non metastatic disease is localized to
uterus.cure rate is 100%.
2. Good prognosis metastatic disease has distant
metastasis with the most common location
being the pelvis or lung.cure rate is >95%.
3. Poor prognosis metastatic disease with most
common metastasis to brain or liver.cure rate is
65%.

16. r

17. Case presentation of
a molar pregnancy

18. Management

19. Gestational amenorrhea
Bleeding prior to 16wks of GA
Passage of grape like vesicles per vaginum
Excessive nausea and vomiting
Distension of abdomen at a higher rate.
Previous history of molar , ectopic
pregnancy or
History of any abortion or miscarriage
History of oedema feet , headache , pain
epigestrum.
HISTORY

20. Examination
Abdominal examination
Fundus larger then dates
Absence of fetal heart tone
Bilateral cystic enlagrgement of the overy
No fetal movments
Anemia in case of heavy bleedig
Vaginal examination
Spotting on vaginal examination
Vesicles may also be seen

21. Clinical presentation

22. Investigations
Baseline investigaion:
 Cbc RBS
 Blood group Rh incompatability
 Screening for hep B nd C
 Urine analaysis,…..
SPECIFIC investigations
b-hcg titer-------baseline for future comprison
Chest x-ray-----to ruled out lung mestatasis
USG……. On USG if there is complete mole,fetus
will be absent and snowstorm appearance of uterus
will be seen.
If fetus is preset and thickened uterus with
honeycomb appearance is seen then it will be
incomplete mole

23. USG findings
Complete mole no fetal
tissue snow storm appeara
Partial mole with some fetal
tissue honey comb appearance

24. TREATMENT
Treatment is based on the histoloy&location
of metastasis;;
After SUCTION & EVACUATIO to empty
the uterus
Will send the sample to histopathology lab
to confirm either it is benign or malignant..
Hysterectomy at who have completed.

25. 3 things to notice here.
1.no fetus,2.uterus full of avascular
cysts,3.rouund uterus inspite of ovoid shape.
COMPLETE MOLE

26. If it is a benign GTN?????
Give the pt ocp for the durion of thr
follow up.
Follow up weekly with serum beta
HCG titer untill negative for 3
weeks,then monthly titer untill
reamain it negative for 12 months.
Follow up is for 1 year
-ve means hCG <5mU/ml)

28. Its diagnosed as GTD and the patient should
be evaluated for a metastatic workup
( CTscans of the brain,thorax,abdomin
and the pelvis)D&C before initiation of
chemotherapy.
If serial b hCG titers plateau or rises then

29. For non metastatic or good
prognosis metastatic disease
1. Administer single chemotherapeutic
agent like methotrexate or actinomycin
D untill weekly beta HCG level become
negative for three weeks,then monthly
titer untill negative for twelve months.
2. Follow up is for 1 year.

30. For poor prognosis
metastatic disease
Administer multiple agent chemotheray (like
methotrexate,actinomycin D and cytoxan)
Chemotherapy will be continued untill weekly beta
HCG level become negative for three weeks,then
monthly titer for 2 years,then every 3 months for
another 3 years.
Follow up is for 5 years

31. Prognosis
Very good
Five years survival after a course of
chemotherapy even when metastasis have
been demonstrated can even be expected in
85% of cases of choriocarcinoma.

32. THANK YOU