Gestational trophoblastic disease (GTD) comprises a spectrum of abnormal proliferation of trophoblast tissue that may have a wide range of behaviors and potential for metastasis. It includes complete and partial hydatidiform moles, as well as gestational trophoblastic neoplasms such as invasive moles, choriocarcinomas, and placental site trophoblastic tumors. Diagnosis is made through beta-hCG levels and imaging, while treatment and prognosis depends on the type of GTD and presence of metastasis.
Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumours. The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to form the placenta during pregnancy.
Gestational trophoblastic disease is a spectrum of interrelated disease processes originating from the placenta.
GTD is a spectrum of tumours with a wide range of biologic behaviour and potential for metastases
They are characterised by an abnormally high amount of HcG levels in the blood
Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumours. The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to form the placenta during pregnancy.
Gestational trophoblastic disease is a spectrum of interrelated disease processes originating from the placenta.
GTD is a spectrum of tumours with a wide range of biologic behaviour and potential for metastases
They are characterised by an abnormally high amount of HcG levels in the blood
Gestational trophoblastic disease (GTD) is a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception. In gestational trophoblastic disease (GTD), a tumor develops inside the uterus from tissue that forms after conception (the joining of sperm and egg).
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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3. Definition
0 Comprises of a spectrum of abnormal proliferation of
the trophoblast which may have a wide range of
biologic behaviour and potential for metastases.
0 The spectrum includes hydatidiform moles
(complete or partial) and gestational trophoblastic
neoplasia comprising invasive moles,
choriocarcinomas, and placental-site trophoblastic
tumours (PSTT).
4. Pathogenesis
0 These tumors develop from an aberrant fertilization
event and arise from fetal tissue within the maternal
host.
0 They are composed of both syncitiotrophoblastic and
cytotrophoblastic cells (except PSTT which is derived
from intermediate trophoblastic cells).
0 First and only disseminated solid tumors that are
highly curable by chemotherapy
5. Types
Benign
1. Hydatidiform mole (complete or Incomplete/partial)
Malignant
1. Invasive or persistent mole,
2. Choriocarcinoma,
3. Placental-site trophoblastic tumour.
0 The last three are termed gestational trophoblastic
tumours (GTT); all may metastasize and are potentially
fatal if untreated.
6. 1. Hydatidiform Mole
0 Most common form
0 Results when tissue around a fertilized egg that normally would
have developed into the placenta instead develops as an
abnormal cluster of cells.
0 Thought to arise from extraembryonic trophoblasts. Studies
suggest that there’s transformation of the embryonic inner cell
mass making it lose it’s capacity to differentiate into embryonic
ectoderm and endoderm. This results in production of
extraembryonic mesoderm and molar vesicles with loose
primitive mesoderm in their villous core
7. Risk factors
0 Women <20 and >40years
0 Nulliparous
0 Low socioeconomic status
0 Diet deficient in protein, folic acid, carotene
0 Blood group A women impregnated by blood group O
8. Complete Hydatidiform Mole
0 Most common type of hydatidiform mole
0 Diffuse trophoblastic hyperplasia, hydropic swelling
of the chorionic villi, no fetal tissue or membranes
present
0 46 XX or 46 XY chromosomes completely paternal of
origin , sex chromatin postive
0 They arise when an empty ovum (w/ absent or
inactivated nucleus) is fertilized by haploid sperm
that duplicates its chromosomes or by two haploid
sperms
9. 0 Risk Factors
• Maternal age >40 years
• Vitamin A deficiency
• Smoking
• Previous molar pregnancy
0 Clinical Features
• Vaginal bleeding
• Pre-eclampsia <20 weeks GA
• Excessive uterine size for LMP
• Theca-lutein cyst > 6cm
• Hyperemesis gravidarum
• β HCG > 100 000 IU/L
• Absence of fetal heart tone
• Hyperthyroidism
10. Partial Hydatidiform Mole
0 Arising when an ovum with an active nucleus is fertilized by a
duplicated sperm or 2 haploid sperms.
0 Hydropic villi and focal trophoblastic hyperplasia are associated
with fetus / fetal parts
0 Triploid (XXY, XYY, XXX) with chromosomes complement from
both parents
0 Associated with fetus, which may be growth-restricted and/or
have multiple congenital malformations
11. Clinical Manifestation
• Typically presents similar to threatened /
spontaneous / missed miscarriage
• Vaginal bleeding
• Absence of fetal heart beat
• Theca lutein cysts
12. Comparisons
Complete Partial
Karyotype Diploid(46XX or 46XY) Triploid (69, XXX or XXY)
Fetus absent Often present
Villi Diffusely hydropic Focally hydropic
Trophoblasts Diffuse hyperplasia Mild focal hyperplasia
Implantation site
trophoblast
Diffuse atypia Focal atypia
P57, PHLDA2
immunostaining
Negative positive
Fetal RBCs absent present
Beta-hCG (mIU per
milliliter
High (>50 000) Slight elevation (>50 000)
Frequency of classical
symtoms
Common rare
Risk of GTT 20-30% <5%
13. Investigations
• Quantitative β HCG levels (will be abnormally high
for GA)
• U/S findings
If complete: No fetus (classic “snow storm” due
to swelling of villi)
If partial : molar degeneration of placenta ± fetal
anomalies, multiple echogenic regions
corresponding to hydropic villi and focal
intrauterine hemorrhage
• CXR (may show metastatic lesions)
14. Ultrasonic findings: Complete
0 Complete Hydatidiform Mole – Snow Storm
• Pattern consists of multiple hypoechoic areas
corresponding to hydropic villi (snow storm)
• A normal gestation or fetus is not presents
• Theca lutein cysts may be visualized
15. Ultrasonic Findings: Partial
0 Partial Hydatidiform Mole
• Focal areas of trophoblastic changes and fetal
tissue may be noted
• Focal cystic changes in the placenta are also a
hallmark finding
16. Management of Gestational
trophoblastic disease
0 Patient resuscitation
0 It is important to confirm whether the mole is invasive or not and
this is done by pelvic ultrasound
0 Resuscitation must include correction of fluid loss, correction of
coagulopathy and blood transfusion for severe anaemia, as well
as prescription of carbimazole and propanolol in the presence of
hyperthyroidism
0 Once it is confirmed that the mole is non-invasive,
0 Then a suction curettage can be done to evacuate the uterus of its
contents
0 A specimen of the evacuated products should be collected and
sent to the laboratory for histological evaluation
0 Oxytocin is administered in theatre and continued for 24 hours
after evacuation OR until bleeding stops
17. 0 Blood loss is usually moderate, but precautions
should be taken for the possibility of hemorrhage
requiring a transfusion.
0 When a large hydatidiform mole (>12weeks) is
evacuated by suction curettage, a laparotomy setup
should be readily available, as hysterotomy,
hysterectomy, or bilateral hypogastric artery ligation
may be necessary if perforation occurs.
0 All Rh negative patients should receive Rh immune
globulin
18. Follow-up
• The patient is advised not to conceive for 12
months and contraception may be prescribed for
those 12 months. This is done to avoid repeat of
GTD
• Serial β HCG every week until negative x3, then
monthly for 6-12 months prior to trying to
conceive
• Increase or plateau of β HCG indicated Gestational
Hydatidiform Neoplasm Patient needs
chemotherapy
20. 1. Invasive or Persistent mole
Invasive mole is reported in 10-15 % of patients
who have had a hydatidiform mole.
It is benign, but as the name implies, it is locally
invasive and invades the myometrium and
adjacent structures.
It has the potential to completely penetrate the
myometrium and cause uterine rupture and lead
to haemoperitoneum.
Metastasis is rare
22. 2. Choriocarcinoma
0 Is reported in 2-5% of all cases of gestational
trophoblastic neoplasia
0 May be accompanied or follow any type of pregnancy
(molar, normal, miscariage)
0 Choriocarcinoma is a pure epithelial tumour
composed of syncytiotrophoblastic and
cytotrophoblastic cells
0 Highly anaplastic and vascular
23. 0 Clinical manifestation
• Often presents with symptoms from metastases
• Late vaginal bleeding in post partum period
• Enlarged uterus
• Enlarged ovaries
• Vaginal lesions
24. 3. Placental - Site
Trophoblastic Tumour
0 Rare aggressive form of gestational trophoblastic tumour
0 The tumour is usually confined to the to the uterus but
local invasion may occur into the myometrium, lymphatics
or vasculature.
0 It metastasizes late in course
0 PSTT is derived from the intermediate trophoblasts of the
placenta bed with minimal or absent syncytiotrophoblastic
tissue
0 As syncytiotrophoblastic cells are generally absent from
this tumour, minimal amounts if hCG are released
0 Production of human placental lactogen (hPL)
25. 0 May arise months or years after
• a hydatidiform mole or
• less commonly after a normal term pregnancy
26. Classification
1. Non-metastatic
• May present with abnormal bleeding
• All have rising or plateau β- hCG
• Negative metastases on staging investigations
2. Metastatic
• More common with choriocarcinoma which tends to
towards early vascular invasion and widespread
dissemination
• Signs and symptoms which are suggestive of
haematogenous spread, do not biopsy (they bleed)
Lungs (cough, hemoptysis)
Vagina (vaginal bleeding, blue lesions)
Pelvis (rectal bleeding)
• Highly vascular tumour bleeding anemia
• All have rising or plateau β- hCG
27. Clinical manifestation
• Abnormal uterine bleeding during 1st trimester
• Nausea & Vomiting (confused with hyperemesis
gravidarum)
• Uterine size greater than expected for their GA
• Multiple theca lutein cysts causing enlargement of
one or both ovaries ( increase risk of malignancy)
• Preeclampsia
• Hyperthyroidism due to stimulation of
thyrotropin by hCG
28. Laboratory findings
• Principal characteristic of gestational
trophoblastic neoplasm is their capacity to
produce hCG
• This hormone may be detected in the serum or
urine of virtually all patients with hydatidiform
mole or malignant trophoblastic disease, its levels
correlates closely with the presence of tumour
cells.
30. Diagnosis
GTN may be diagnosed when any of the following criteria are
met
1. When the plataeau of hCG levels last for four
measurements (days 1,7,14,21) over a period of three
weeks or longer.
2. When there is a rise in hCG level for three weekly
consecutive measurements (days 1, 7 and 14) or longer,
over a period of at least two weeks or more.
3. When the hCG levels remain elevated for six months or
more.
4. When there is histological diagnosis of choriocarcinoma.
31. Management of GTN
1. Scoring according to the FIGO 2000 staging system
2. Low risk patients have a score of 6 or less. High risk
7 or more
3. High risk treat with methotrexate and Dactinomycin
followed by folinic acid
4. If 7 or more chemotherapy
5. If PSTT hysterectomy
32. Staging
Modified WHO Prognostic Scoring System as Adapted by FIGOb
Scores 0 1 2 4
Age <40 ≥40 – –
Antecedent pregnancy mole abortion term –
Interval months from
index pregnancy
<4 4–6 7–12 >12
Pretreatment serum hCG
(iu/1)
<103 103–104 104–105 >105
Largest tumor size
(including uterus)
<3 3–4 cm ≥5 cm –
Site of metastases lung spleen, kidney gastrointestinal liver, brain
Number of metastases – 1–4 5–8 >8
Previous failed
chemotherapy
– – single drug ≥2 drugs
33. Investigations for staging
• History and Physical Examination
• Bloodwork: FBC, electrolytes, creatinine, β-hCG,
TSH, LFTs
• Imaging: CXR, U/S pelvis, CT abdo/pelvis, CT
brain
34. Differential Diagnosis
0 Normal pregnancy
0 Aborting pregnancy
0 Ectopic pregnancy
Complications
0 Deportation of trophoblastic tissue through the
maternal-fetal barrier to the lungs
0 Pulmonary emboli
35. References
0 Decherney., A.H., & Nathan.,L. (2007). Current
diagnosis & treatment. USA: The McGraw hill, Cenveo
publisher.
0 Hoffman., B.L., Schorge.J.O & Schaffer., J.I. (2012).
William Gynecology. USA, Texas:The McGraw hill
Editor's Notes
PHLDA2 – the product of a paternally imprinted, maternally expressed gene stained by p57 immunochemistry. Complete moles stain negative as their genome is exclusively paternally and cannot express PHLDA2 .
Classical symptoms include: hyperemesis, hyperthyrodism, excessive uterine enlargement, anaemia and preeclampsia