- Trophoblastic diseases: partial & complete hydatid moles and choriocarcinoma - Causes of abnormal uterine bleeding (AUB)

1. Manal Ismail Abd-Elghany
Associate Professor of Pathology, PhD (UK),
MD(Egypt)
Trophoblastic Diseases

2. GESTATIONAL
TROPHOBLASTIC DISEASES

3.  Definition: Gestational trophoblastic disease (benign
tumor of the chorionic villus) resulting from abnormal
fertilization of an ovum and characterized by abnormal
proliferation of trophoblastic cells. It is also called vesicular
mole.
 The incidence: is 7–10 times higher in Southeast Asian
countries than in the Western world. Occurs in 1 of 1500
pregnancies in the United States.
 Risk factors: Increased maternal age is only a risk factor
for complete mole and not partial mole.
 Types: Hydatidiform moles are classified into two different
types:
A. Complete mole
B. Partial mole
1
Hydatidiform Mole

4.  A. Complete mole:
 Results from fertilization of an empty ovum by two sperms
or a haploid sperm that divides its nuclear material and
forms diploid chromosomes (46,XX or 46,XY).
 Therefore, the complete mole is completely paternal in
origin.
 Fetal parts are completely absent.
 The placenta is completely neoplastic.
 B. Partial mole:
 Results from fertilization of a normal ovum by two sperm
cells or duplication of one sperm. It has triploid
chromosomes (69,XXY, 69,XXX, or 69,XYY).
 Partial mole is both maternal and paternal in origin and
partially consists of identifiable fetal parts.
 Not all placental villi are neoplastic. 2

5. 3a

6. 3b

7.  Presentation:
A. Complete mole:
 The most common presentation is first-trimester
vaginal bleeding.
 Additional features include mainly excessive
elevations in hCG, excessive uterine size,
symptoms of preeclampsia in the first trimester
& hyperthyroidism.
B. Partial mole:
 The most common presentations include:
vaginal bleeding or the features of missed or
incomplete abortion.
 The uterus is usually small for date. 4

8.  Pathological features of Complete mole:
 Grossly:
 The uterus is enlarged and characteristically filled
with grape-like vesicles. The vesicles contain clear
watery fluid.
 Microscopically:
 Large & edematous villi due to hydropic
degeneration.
 Stroma is avascular.
 Trophoblastic proliferation in both cytotrophoblast
and syncytiotrophoblast, generally circumferential
around the villi i.e. diffuse. 5

11. Complete mole

12. Complete mole

13.  Pathological features of Partial mole:
 Grossly:
 The uterus contains some cystic villi.
 Part of the placenta appears normal.
 A fetus with multiple malformations is often present.
 Microscopically:
 Some of the villi show edematous change while
others are normal or even fibrotic.
 Trophoblastic proliferation is usually slight & focal.
6

14. slide 3 of 3
Partial mole. A fetus is present (he
had
malformations).

15. Partial mole
 Heterogeneity in villous size with 2 discrete populations:
1. Large, hydropic villi &
2. Small, normal, fibrotic villi

16. Partial mole

17. 7
First Aid for The Basic Sciences Organ Systems (2017): Reproductive, Chapter 9,
3rd ed. page 711.

18. Choriocarcinoma

19.  Definition:
 Choriocarcinoma is an aggressive, malignant tumor arising
from gestational chorionic epithelium.
 Incidence:
 It usually follow evacuation of a mole, with 2% of complete
moles becoming choriocarcinoma.
 Presentation:
 Recurrent vaginal bleeding after evacuation of a complete
mole or following delivery, ectopic pregnancy, or abortion.
 Levels of hCG continue to rise after evacuation.
 Metastases:
 Spread hematogenously to the lung (50%), vagina (35%),
liver, and brain.
8

20.  Grossly:
 It appears as fleshy or soft, hemorrhagic,
necrotic masses within the uterus.
 Microscopically:
 Choriocarcinoma has a distinctive biphasic
appearance consisting of mononucleated
trophoblastic cells (with clear cytoplasm)
and multinucleated syncytio-
trophoblasts (with deeply eosinophilic
cytoplasm). There are no chorionic villi.
9

22. slide 7 of 105
Choriocarcinoma

23. Abnormal Uterine Bleeding
“AUB”

24. Abnormal Uterine Bleeding AUB (according to age group)
10

25. 11

26. Abnormal Uterine Bleeding (AUB)
PALM COEIN