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GTD Final

Gestational Trophoblastic Diseases (GTD) are a group of disorders resulting from abnormal placental trophoblast proliferation, with risk factors including age, prior molar pregnancies, and dietary influences. The document details the pathology, clinical features, diagnosis, and management of hydatidiform moles, invasive moles, placental site trophoblastic tumors, and choriocarcinoma, highlighting their distinct characteristics and treatment approaches. Complications associated with GTD include immediate risks such as hemorrhage and preeclampsia, as well as late complications like choriocarcinoma.

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Vedehi Bansal
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9 views44 pages

GTD Final

Gestational Trophoblastic Diseases (GTD) are a group of disorders resulting from abnormal placental trophoblast proliferation, with risk factors including age, prior molar pregnancies, and dietary influences. The document details the pathology, clinical features, diagnosis, and management of hydatidiform moles, invasive moles, placental site trophoblastic tumors, and choriocarcinoma, highlighting their distinct characteristics and treatment approaches. Complications associated with GTD include immediate risks such as hemorrhage and preeclampsia, as well as late complications like choriocarcinoma.

Uploaded by

Vedehi Bansal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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GESTATIONAL TROPHOBLASTIC

DISEASES
MBBS class 14.09.2023
INTRODUCTION

• Gestational Trophoblastic Disease are


heterogenous group of interlesional disorders
that arise from abnormal proliferation of
Placental trophoblast.
NORMAL PLACENTA
RISK FACTORS

 Age- extremes <15 yr and >40 yr


 Prior Molar pregnancy
 Previous spontaneous abortion (2X incidence)
 Diet- increased incidence in high carbohydrate diet,
low protein and Vit. A or Carotene diet
 Malnutrition and Debilitated condition
 Maternal blood group AB and A
PATHOLOGY OF HYDATIDIFORM MOLE

• Most of the moles are found in uterus but may


occur in other sites including site of ectopic
pregnancy.
• The uterine cavity is filled with a delicate soft friable
mass of thin walled translucent cystic grape like
structures .
• In complete mole no foetal parts or normal villi
seen.
• In partial mole foetus may be seen and only part of
the villi show cystic change.
HYDATIDIFORM MOLE
A. Uterus containing hydatidiform mole
B. Hydatidiform mole -microscopy
HYDATIDIFORM MOLE
• CLINICAL FEATURES :
Moles can occur at any age during
reproductive life but more common in teens
and between the age of 40 and 50.
• SYMPTOMS :
Bleeding during 4th or 5th month of pregnancy
- Uterus is usually large for the period of
gestation.
HYDATIDIFORM MOLE
• SYMPTOMS ( contd ):
- Passing bits of tissue or small vesicles per vagina.

• DIAGNOSIS :
1. High serum HCG level.
2. Ultrasonography of uterus and FGT
3. Histopathological study of evacuated material.
USG OF MOLAR PREGNANCY- ‘SNOW STORM APPEARANCE
ORIGIN OF COMPLETE AND PARTIAL HYDATIDIFORM
MOLES
ORIGIN OF COMPLETE AND PARTIAL HYDATIDIFORM
MOLES
PARTIAL MOLE

• IT IS CHARACTERISED BY CYSTIC SWELLING


OF ONLY A PORTION OF CHORIONIC VILLI
WITH MINIMUM TROPHOBLASTIC
PROLIFERATION OF ONLY
SYNCYTIOTROPHOBLASTS.
MICROSCOPY

• PARTIAL MOLE :

1. Few villi are affected


2. Minimal synctio trophobalstic proliferation
and no trophoblastic atypia.
COMPLETE MOLE

• IT IS CHARACTERISED BY CYSTIC SWELLING


OF MOST OF THE CHORIONIC VILLI ALONG
WITH VARIABLE TROPHOBLASTIC
PROLIFERATION
COMPLETE HYDATIDIFORM MOLE
Complete hydatidiform mole suspended in saline
showing numerous swollen (hydropic) villi
MICROSCOPY

• COMPLETE MOLE:
1. All villi are affected.
2. They show marked cystic change with
oedmatous avascular core.
3. Variable degree of both cyto and synctio
trophoblastic proliferation.
4. Variable degree of trophoblastic atypia.
Complete hydatidiform mole demonstrating marked villous
enlargement , edema, circumferential trophoblastic proliferation
A, Photomicrograph of partial hydatidiform mole revealing swollen villi and
slight hyperplasia of the surface trophoblast.
B, Complete hydatidiform mole with extensive cytotrophoblastic hyperplasia
A. Normal chorionic villi immunostained for p57 exhibit staining in both
stromal and cytotrophoblast nuclei.
B. Complete mole lacks expression of p57 in the cytotrophoblast and villous
stroma.
INVASIVE MOLE

• IT IS A COMPLETE MOLE WHICH INVADES THE


MYOMETRIUM TO A VARIBALE EXTENT ,
SOMETIMES COMPLETE PERFORATION OF THE

UTERINE WALL ASSOCIATED WITH


TROPHOBLASTIC PROLIFERATION.
A, Invasive mole presenting as a hemorrhagic mass adherent to
the uterine wall. B, On cross-section, the tumor invades
into the myometrium.
MICROSCOPY

• INVASIVE MOLE :
1. The cystic chorionic villi partly or completely
invade the myometrium including the
parametrial tissue and blood vessels.
2. Hydropic villi may even embolise distant
sites like lungs and brain but do not grow
here as neoplasms.
MANAGEMENT OF MOLAR PREGNANCY
- The patient should be made hemodynamically
stable.

Medical care- involves correction of Anemia,


dehydration, Hypertension etc.

Surgical care- Suction and Evacuation (method


of choice)
• In Partial mole, management depends on fetal
parts-
Small fetal parts- Suction and Evacuation
Large fetal parts- Medical
management(Oxytocics)
-Anti D prophlaxis (not required in Complete
mole)

• Hystrectomy >40 years , if patient has no


desire for further pregnancy
• Chemotherapy in high risk cases when follow
up is unavailable or unreliable. eg.
Age >40 yrs
Previous history of Molar pregnancy
Beta –HCG levels >1,00,000 m IU/ml
Uterine size greater than gestational age

• Follow up with serial Beta HCG levels


PLACENTAL SITE TROPHOBLASTIC TUMOUR

• IT IS A TUMOUR CHARACTERISED BY THE


PROLIFERATION OF PREDOMINENTLY
INTERMEDIATE TROPHOBLASTS WHICH ARE
FOUND AT THE IMPLANTATION SITE AND
PLACENTAL MEMBRANE.
PLACENTAL SITE TROPHOBLASTIC TUMOUR

• GROSS PATHOLOGY :
It usually presents as localised or ill defined
mass in the myometrium.
• MICROSCOPY :
Round to polygonal cells with abundant
cytoplasm and round nuclei infiltrating the
endometrium and myometrium along with few
cyto and syncytio trophoblasts . No biphasic
pattern of choriocarcinoma.
A, Placental site trophoblastic tumor, presenting as a
discrete mass in the myometrium. B, Histology of PSTT
PLACENTAL SITE TROPHOBLASTIC TUMOUR

• DIAGNOSIS :
1. USG
2. HCG LEVEL
3. HUMAN PLACENTAL LACTOGEN LEVEL
4. HISTOPATHOLOGY
CHORIOCARCINOMA
• Gestational choriocarcinoma is an epithelial
malignant tumour of trophoblastic cells
derived from any form of previously normal or
abnormal pregnancy.

• “ It is a very aggressive , rapidly invasive ,


widely metastasising malignant tumour.
CHORIOCARCINOMA
• INCIDENCE :
1 in 20,000 - 1 in 30,000 pregnancies
More common in African countries.

• GROSS PATHOLOGY :
Usually present as soft fleshy haemorrhagic
yellowish brown tumour masses with extensive
pale or white areas of ishemic necrosis.
ORIGIN AND INCIDENCE OF CHORIOCARCINOMA
CHORIOCARCINOMA
• MICROSCOPY :
1. Extensive ‘biphasic’ proliferation of
cytotrophoblasts and synctiotrophoblasts
without villi formation.
2. Severe pleomorphism, atypical mitosis and
hyperchromasia.
3. Extensive areas of haemorrhage and necrosis.
4. Extensive infiltration of underlying tissue and
blood vessels.
A, Choriocarcinoma presenting as a bulky hemorrhagic mass invading
the uterine wall. B, Photomicrograph of choriocarcinoma
illustrating both neoplastic cytotrophoblast and syncytiotrophoblast
CHORIOCARCINOMA
• CLINICAL FEATURES :
1. Irregular uterine bleeding or spotting of bloody,
brownish foul smelling fluid, during or after
pregnancy , abortion or curettage.
2. Extensive metastasis of distant organs.

• DIAGNOSIS :
1. HCG
2. Scanning
3. Histopathology.
COMPARAITIVE FEATURES OF MAJOR FORMS OF
GESTATIONAL TROPHOBLASTIC DISEASES
COMPLICATIONS
 IMMEDIATE
• Massive hemorrhage
• Early onset Preeclampsia and Eclampsia
• Hyperemesis Gravidum
• Pulmonary Embolism
• Uterine Perforation
• Still birth
• Preterm birth

 LATE
• Choriocarcinoma

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