For medical students

1. GESTATIONAL TROPHOBLASTIC
DISEASES
DR.KHAMIS
29/07/24

2. • Introduction
• Classifications
• Risk factors
• Etiology and treatment

3. • GTD is a class of conditions characterized by
abnormal trophoblast-cell growth in the uterus.

4. Classifications
• Hyatidiform moles(molar pregnancy)
i) Partial mole
ii) Complete mole
• Gestational Trophoblastic Neoplasia (GTN)
I. Choriocarcinoma
II. Invasive mole
III. Placental site trophoblastic tumors
IV. Epitheliod trophoblastic tumors

6. Hyatidiform moles
• Risk factors
-prior molar pregnancy
-extremes of age <15 and >35
-history of miscarriage and infertility

7. characteristics
• Proliferate within the uterus without
myometrial infiltration or hematogenic
dissemination.
• may undergo malignant transformation to an
invasive mole

8. Complete mole
• Etiology: fertilization of an empty egg that does
not carry any chromosomes by a single sperm.
• Fetal karyotype:
-46XX(90%)
-46XY(10%)
• Pathophysiology; hydropic degeneration of
chorionic villi with proliferation of
cytotrophoblast and syncytiotrophoblasts>death
of the embryo.

10. Clinical features
• PVB in the first trimester
• Large for dates pregnancy
• Passage of vesicles PV
• Pelvic pressure/pain
• Beta HCG mediated endocrine conditions:
-Theca lutein cysts
-Preeclampsia
-Hyperemesis gravidarum
-hyperthyroidism

11. Diagnosis
• Baseline quantitative beta HCG
(complete>partial)
• Histopathology
• Immunohistochemistry marker; p57 negative
• Pelvic US; mass with many hypoechogenic cystic
spaces representing hydropic villi( honeycomb,
bunch of grapes, or snowstorm) with bilateral
ovarian theca lutein cysts

13. Partial mole
• Etiology
-fertilization of an egg containing a haploid set
of chromosomes with two sperms
-a haploid ovum with reduplication of the
partenal haploid set from a single sperm
• 69XXY
• 69XXX
• 69XYY(rare)

14. Clinical features and diagnosis
• No change in uterine size
• Beta HCG mediated endocrine conditions are
less common
• Histopathological exam; partial occurrence of
hydropic villi, minimal trophoblastic
proliferation
• Immunohistochemistry marker; p57 positive

15. • On U/S
-fetal parts
-Amniotic fluid
-Heart beat
-increased placental thickness
-multicystic avascular hypoechoic or anechoic
spaces(referred to as “swiss cheese”
appearance)

16. Gestational Trophoblastic Neoplasia(GTN)
• Choriocarcinoma
A highly malignant GTN characterized by
invasive,highly vascular and anaplastic
trophoblastc tissue without villi.
Metastasis : lungs, vagina, CNS, liver, pelvis,
GIT, and kidneys

17. Clinical features
• Depends on extent of disease and location of
mets
• Postpartum PVB and inadequate uterine
involution
• Beta HCG mediated endocrine conditions
• Others; dyspnea, cough, hemoptysis, seizures,
headaches or visible vascular lesions in the
vagina

18. Diagnosis
• Quatitative HCG
• CXR (cannonball lesions)
• Histopathologic exam; anaplastic
cytotrophoblast and syncytiotrophoblast
without chorionic villi

19. Treatment
• Treatment of choice is methotrexate(MTX) or
dactinomycin.
• Low risk,monotherapy with MTX or
actinomycin D
• High risk; multi agent chemotherapy
consisting of MTX, actinomycin D,etoposide,
cyclophosphamide or vincristine

20. • Surgical treatment i.e hysterectomy to stop
bleeding from lesion or to excise distant
metastasis
• Beta HCG should be monitored for at least 12
months
• Prognosis; less than 1% risk of recurrence
-worse prognosis in advanced disease

21. Invasive mole
• Definition; a form of GTD characterized by
malignant transformation of an incomplete or
complete mole.
• Etiology
Complete(15-20%)
Incomplete (<5%)

22. • Pathophysiology; trophoblasts infiltrate the
myometrium>increased risk of uterine
perforation, intraperitoneal hemorrhage or
infection.
• Hematogenic dissemination
• Often detected on post treatment surveillance
of hyatidiform moles

23. • On U/S; a poorly defined uterine mass with
potential invasion into the myometrium
• Treated similar to choriocarcinoma, usually
detected earlier and responds to
monotherapy
• Prognosis; risk of recurrence <1%
• Evaluate future pregnancies for signs of molar
disease.

24. • Placental site trophoblastic tumor is a rare type
of potential malignant GTN that is
characterized by the absence of villi, decreased
syncytiotrophoblast cells and proliferation of
intermidiate trophobblast cells.
• Epitheliod trophoblastic tumour is
characterized by nests, cords, and/or sheets of
intermediate trophoblastic cells with
eosinophilic to clear cytoplasm.

25. Thank you.