Trophoblastic Disease

molar pregnancy

more common in younger or older age groups

trophoblast

thin layer of cells helping embryo attach to uterine wall, protecting embryo & forming part of placenta

gestational trophoblastic disease (GTD)

group of interrelated tumors originating from placenta

maternal vs. paternal genes

maternal- control growth of embryo

paternal- control trophoblastic tissue that becomes placenta

excessive paternal genes can cause GTD

GTD clinical findings

rapid enlargement of uterus w/cystic material cischarge

grossly high hCG levels

hyperemesis (severe type of nausea/vomiting)

uterine bleeding in 1st trimester

theca-lutein cysts

onset of pre-eclampsia

hyperthyroidism

types of GTD

complete hydatidifrom mole

partial mole

mole with coexisting fetus

complete hydatidiform mole

*most common form*

fluid & tissue swelling w/no getal tissue present

5% risk of recurrence if prior complete molar

complete hydatidiform mole on US

filling of endo cavity with heterogenous echogenic material (cysts)

vesicular appearance

increased uterine size

sometimes fluid collections surrounding molar mass

mimics degenerating myoma

what causes theca-lutein cysts in molar cases?

high hCG levels cause these in complete hydatidiform moles in 50% of cases

partial mole

has presence of a fetus (typically abnormal & w/trisomy 21)

triploidy = rare chromosomal abnormality where fetuses are born with extra set of chromosomes

partial mole on US

grossly enlarged placenta w/various sized cystic areas within

focal or diffuse areas of increased echogencicity in placenta

coexisting fetal tissue w/grossly abnormal fetus

mole with coexisting fetus

hydatidifrom with coexisting fetus is outside realm of true GTD

actually, 2 conceptions occur; 1 normal and 1 molar

looks similar to partial mole

partail mole vs. mole w/coexisting fetus

important to distinguish difference b/c partial mole will ALWAYS be evacuated but not so clear cut with coexisting fetus

hydropic degeneration of placenta

pathologic pehenomenon by presence of numerous cystic areas w/in enlarged placenta

not considered part pf GTD, but increases risk of fetal demise

persistent trophblastic neoplasia & US

complication of pregnancy commonly following GTD

after treatment of molar, some molar tissue is left behind & starts growing into tumor

if left untreated, can progress to malignant type of GTD

heterogenous uterine mass, multiple lacunae, low resistance flow

gestational trophoblastic neoplasia & types

AKA gynecologic tumors that originate in trophoblastic tissue

classifications: invasive mole, uterine choriocarcinoma, placental site trophoblastic tumors (PSTTs), epitheliod trophoblastic neoplasia

invasive mole & US

AKA chorioadenoma destruens

rare, molar tissue invades myometrium or adjacent structures

considered malignant form of GTD

US: hypervascular, swiss cheese, irregular cystic areas into myometrium

uterine choriocarcinoma & US

AKA gestational choriocarcinoma

pure epithelial tumor

considered malignant metastatic form of GTD

2 trophoblast layers: syncytiotrophoblast & cytotrophoblast

US: enlarged uterus, eccentrically situated irregular, complex mass in UT, low-resistance flow in/around mass

placental sit trophoblastic tumor & US

rare form of GTD

arises from placental implantation site

tumor cells infiltrate myometrium

US: enlarged UT, heterogenous lesion, anechoic space around lesion w/low-resistance flow

gold standard for molar pregnancies

histological confirmation

what is molar pregnancy associated with?

very early-onset preeclampsia

molar placentas produce more anti-angiogenic proteins that results in hypertension, proteinuria, & other symptoms of preeclampsia