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Gestational Trophoblastic Disease (GTD)

Gestational Trophoblastic Disease (GTD). Types of GTD. Benign Hydatidiform mole/molar pregnancy (complete or incomplete) malignant Invasive mole Choriocarcinoma ( chorioepithelioma ). Types of GTD. The term Gestational Trophoblastic Tumors has been applied the latter three conditions

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Gestational Trophoblastic Disease (GTD)

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  1. Gestational Trophoblastic Disease (GTD)

  2. Types of GTD Benign • Hydatidiform mole/molar pregnancy (complete or incomplete) malignant • Invasive mole • Choriocarcinoma (chorioepithelioma)

  3. Types of GTD • The term Gestational Trophoblastic Tumors has been applied the latter three conditions • Arise from the trophoblastic elements • Retain the invasive tendencies of the normal placenta or metastasis • Keep secretion of the human chorionic gonadotropin (hCG)

  4. Hydatidiform Mole (molar pregnancy)

  5. Definition and Etiology • Hydatidiform mole is a pregnancy characterized by vesicular swelling of placental villi and usually the absence of an intact fetus. • The etiology of hydatidiform mole remains unclear, but it appears to be due to abnormal gametogenesis and fertilization

  6. Definition and Etiology • In a ‘complete mole’ the mass of tissue is completely made up of abnormal cells • There is no fetus and nothing can be found at the time of the first scan.

  7. Definition and Etiology • In a ‘partial mole’, the mass may contain both these abnormal cells and often a fetus that has severe defects. • In this case the fetus will be consumed ( destroyed) by the growing abnormal mass very quickly.(shrink)

  8. Incidence • 1 out of 1500-2000 pregnancies in the U.S. and Europe • 1 out of 500-600 (another report 1%) pregnancies in some Asian countries. • Complete > incomplete

  9. Incidence • Repeat hydatidiform moles occure in 0.5-2.6% of patients, and these patiens have a subsequent greater risk of developing invasive mole or choriocarcinoma • There is an increased risk of molar pregnancy for women over the age 40

  10. Incidence • Approximately 10-17% of hydatidiform moles will result in invasive mole • Approximately 2-3% of hydatidiform moles progress to choriocarcinoma ( most of them are curable) Not definitely benign disease , has a tight relationship with GTT

  11. The microscopic appearance of hydatidiform mole: • Hyperplasia of trophobasitc cells • Hydropic swelling of all villi • Vessles are usually absent

  12. Signs and Symptoms of Complete Hydatidiform Mole • Vaginal bleeding • Hyperemesis ( severe vomit) • Size inconsistent with gestational age( with no fetal heart beating and fetal movement) • Preeclampsia • Theca lutein ovarian cysts

  13. Signs and Symptoms of Partial Hydatidiform Mole • Vaginal bleeding • Absence of fetal heart tones • Uterine enlargement and preeclampsia is reported in only 3% of patients. • Theca lutein cysts, hyperemesis is rare.

  14. Invasive mole

  15. Definition This term is applied to a molar pregnancy in which molar villi grow into the myometrium or its blood vessels, and may extend into the broad ligament and metastasize to the lungs, the vagina or the vulva.

  16. Common Sites for Metastatic Gestational Trophoblastic Tumors

  17. Choriocarcinoma

  18. Definition A malignant form of GTD which can develop from a hydatidiform mole or from placental trophoblast cells associated with a healthy fetus ,an abortion or an ectopic pregnancy.

  19. Definition • Characterized by abnormal trophoblastic hyperplasia and anaplasia , absence of chorionic villi

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