Gestational Trophoblastic Disease

Gestational Trophoblastic Disease

• Molar Changes

• 3 types: Complete, Partial, or Coexistent

Complete Hydatidiform Mole

• Most common neopasm that arises from the trophoblast

• May develop into choriocarcinoma

• Complete hydatidiform moles are masses that arise from either:

  • fertilization of a defective ovum by a single sperm

  • OR fertilization of one ovum by two sperm

Partial Hydatidiform Mole

• Partial (Incomplete) Mole results from triploid karyotype (69 chromosomes) in about 90% of cases

• Little malignant potential

• Has focal and less advanced hydatidiform changes w/ slowly progressing swelling of avascular villi

  • some avascular villi are spared

• hyperplasia of the trophoblast is focal

Potential findings of a partial hydatidiform mole includes:

• abnormal fetus / fetal tissue

• thick placenta

• oligohydramnios

• **there may be a co-existing fetus (non-viable), fetal parts or an amniotic sac

Coexistent Molar & Fetus

• Rare

• results from hydatidiform degeneration of twins

• More likely w/ 2 placentas, coexisting fetus alive w/ normal placenta

Hydatidiform Mole

• Ovarian theca lutein cysts are found in 20-35% of pt’s w/ hydatidiform moles

  • caused by overstimulation of ovarian tissue by large amounts of hCG secreted by the proliferating trophoblast

Theca Lutein Cysts

• Bilateral

• contain multiple cysts + septa

• Largest when hCG production at greatest

  • 12 - 24 weeks GA

• Have potential to twist and hemorrhage, causing areas of solid echogenicity within cyst

Hydatidiform Mole Labs:

• Elevated beta hCG levels

  • stay high or continuously rise beyond 100 days after LMP

    • (there is normally a decline)

Invasive Mole AKA:

Chorioadenoma Destruens

Invasive Mole

• Malignant, non-metastatic trophoblastic disease

• result from malignant progression of hydatidiform moles

Chorioadenoma Destruens

Excessive trophoblastic overgrowth and penetration by the trophoblastic elements, including whole villi, into the depths of the myometrium, sometimes penetrating the uterine wall and involving the peritoneum

Choriocarcinoma

• most malignant form of GTD

• malignant, metastatic gestational trophoblastic disease

• lungs and vagina most common sites for mets

• it is classified microscopically as sheets of highly malignant trophoblast of both cytotrophoblast and synctiotrophoblast elements, with no villous structures

What do choriocarcinomas arise from?

• 50% develop from a hydatidiform mole

• 50% evolve from a normal pregnancy, occur after AB, or post ectopic

What is the treatment for choriocarcinoma?

• Pt is placed on Birth Control Pill for 1 year to prevent pregnancy

• hCG is performed every 1-2 weeks after primary treatment until results of 3 consecutive tests are normal, then monthly for 6 months, and then every other month for 6 months

• Regression should occur within 2-3 months

What is the treatment for choriocarcinoma?

• Recurrence is suspected if the hCG level reaches a plateau and remains there for 3 weeks or increases over 2 weeks

• Recurrent molar pregnancy confined to the pelvic region is treated with chemotherapy

  • Methotrexate

  • Actinomyocin D

• Surgical intervention

  • hysterectomy