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.
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
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)
2 types of hydatidiform mole
Genetically either two sperms fertilize
an empty ovum or one sperm
duplicates / 46xx
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
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.
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
LAB AND USG
Incomplete or partial mole
Triploid – 2 sets of paternal and
one set of maternal
Patient presents with pregnancy and irregular
U/S – Embryo with molar changes in placenta
Early fetal death
It is malignant neoplasm of
trophoblastic cells derived from a
previously normal or abnormal
Rapidly invasive and
Good response to chemotherapy
in comparison to choriocarcioma
arising in ovary from germ cell.
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 ,
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
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
History of any abortion or miscarriage
History of oedema feet , headache , pain
Fundus larger then dates
Absence of fetal heart tone
Bilateral cystic enlagrgement of the overy
No fetal movments
Anemia in case of heavy bleedig
Spotting on vaginal examination
Vesicles may also be seen
Blood group Rh incompatability
Screening for hep B nd C
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
Complete mole no fetal
tissue snow storm appeara
Partial mole with some fetal
tissue honey comb appearance
Treatment is based on the histoloy&location
After SUCTION & EVACUATIO to empty
Will send the sample to histopathology lab
to confirm either it is benign or malignant..
Hysterectomy at who have completed.
3 things to notice here.
1.no fetus,2.uterus full of avascular
cysts,3.rouund uterus inspite of ovoid shape.
If it is a benign GTN?????
Give the pt ocp for the durion of thr
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)
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
If serial b hCG titers plateau or rises then
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.
For poor prognosis
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
Five years survival after a course of
chemotherapy even when metastasis have
been demonstrated can even be expected in
85% of cases of choriocarcinoma.