Trophoblastic Disease

Molar Pregnancy

Approximately 1/1000 - 1200 pregnancies is a molar pregnancy.

More common under 20 years of age and over age 35

Gestational trophoblastic disease (GTD)

a group of interrelated tumors originating from the placenta

Trophoblast

A thin layer of cells that helps a developing embryo attach to the wall of the uterus, protects the embryo, and forms a part of the placenta

Rapid enlargement of the uterus

with the expulsion of cystic vesicles through the vagina.

Grossly elevated beta

hCG levels

Hyperemesis gravidarum

A severe type of nausea and vomiting during pregnancy

Uterine bleeding

in the first trimester

other clinical findings for GTD

Theca-lutein cysts

Onset of pre-eclampsia

Hyperthyroidism

Complete Hydatidiform Mole

the most common form of gestational trophoblastic disease and occurs in 1 in 1200 pregnancies in the United States

partial mole

mole with coexisting fetus

Complete Hydatidiform Mole sonographic signs

Filling of the endometrial cavity with heterogeneous echogenic material

A vesicular appearance

Increased uterine size

Fluid collections surrounding a molar mass (not

always but sometimes)

Appearance that mimics a degenerating myoma

High hCG causes multiple theca lutein cysts in approx

50% of case

Partial Mole Sonographic Signs

Grossly enlarged placenta with variously sized cystic

areas within (molar placenta)

Focal or diffuse areas of increased echogenicity in or

about the placenta

Presence of coexisting fetal tissue (in which case the

diagnosis is virtually certain). Grossly abnormal fetus

(triploidy malformations)

Hydropic Degeneration of the Placenta

A pathologic phenomenon characterized by the presence of numerous cystic areas within a generally enlarged placenta

Persistent Trophoblastic Neoplasia

A complication of pregnancy that most commonly follows gestational

trophoblastic disease by can also (uncommonly) occur after normal

term delivery, spontaneous abortion, or even ectopic pregnancy

Gestational Trophoblastic Neoplasia

Gynecologic tumors that originate in trophoblastic tissue

Gestational Trophoblastic Neoplasia Classifications

invasive Mole

Uterine Choriocarcinoma

Placental site trophoblastic

tumors (PSTTs)

Epithelioid trophoblastic

neoplasia

Invasive Mole aka chorioadenoma destruens

Rare, molar tissue invades the myometrium or adjacent

anatomic structures

Uterine Choriocarcinoma aka gestational choriocarcinoma

considered the malignant, metastatic form of gestational trophoblastic disease

Placental Site Trophoblastic Tumor

A rare form of gestational trophoblastic disease that may occur after delivery of a normal pregnancy, following evacuation and treatment of a hydatidiform mole, or even after a terminated pregnancy