GESTATIONAL TROPHOBLASTIC DISEASE.ppt pathology

Gestational trophoblastic disease

1. GESTATIONAL TROPHOBLASTIC
DISEASE

2. INTRODUCTION
•It consists of a spectrum of tumors and tumorlike
conditions.
•They are characterized by proliferation of placental tissue,
either villous or trophoblastic
•Caused by benign and malignant overgrowth of trophoblast

3. MAJOR DISORDERS
•Hydatidiform mole (complete and partial)
•Invasive mole
•Choriocarcinoma
•Placental site trophoblastic tumour (PSTT).

4. HYDATIDIFORM MOLE
•They are associated with an increased risk of persistent trophoblastic
disease.
•Histologically characterized by cystic swelling of the chorionic villi and
variable trophoblastic proliferation.
•Diagnosed during early pregnancy by pelvic sonography (9 weeks)
•Can develop at any age- more common in teens and 50’s
•Two types of benign, non-invasive mole :-
• Complete
• Partial
•Differentiated by cytogenetic and histologic studies.

5. Complete Mole
•Results from fertilization of an egg that has lost its female
chromosomes, and as a result the genetic material is
completely paternally derived.
•90% have a 46,XX karyotype originating from the duplication
of the genetic material of one sperm.
•The remaining 10% result from the fertilization of an empty
egg by two sperms; these may have a 46,XX or 46,XY
karyotype.
•The embryo dies very early in development and therefore is
usually not identified.

6. Partial Mole
•Result from fertilization of an egg with two sperm.
•In these moles, the karyotype is triploid or occasionally
tetraploid.
•Fetal tissues are typically present.
•Partial moles have an increased risk of persistent molar
disease but are not associated with choriocarcinoma.

8. Morphology
•Hydatidiform mole appears as a delicate, friable mass of
thin-walled, translucent, cystic, grapelike structures
consisting of swollen oedematous (hydropic) villi.
•In complete mole, the chorionic villi are enlarged, scalloped
in shape with central cavitation (cisterns), and covered by
extensive trophoblast proliferation that involves the entire
circumference of the villi.
•In partial moles, only a fraction of the villi are enlarged and
edematous, and the trophoblastic hyperplasia is focal and
less marked than in complete moles.

9. Clinical Features
•Spontaneous miscarriage or undergo curettage because of
ultrasound findings of abnormal villous enlargement.
•hCG levels greatly exceed those of a normal pregnancy of
similar gestational age.
•The rate at which hCG levels rise over time in molar
pregnancy exceeds
•Most moles are successfully removed by curettage.
•Continuous elevation of hCG may be indicative of persistent
or invasive mole

10. Invasive Mole
•It is an infiltrative lesion that penetrates or even perforates
the uterine wall.
•There is invasion of the myometrium by hydropic chorionic
villi.
•It is accompanied by proliferation of both cytotrophoblasts
and syncytiotrophoblasts.
•Clinically manifested with vaginal bleeding and irregular
uterine enlargement and associated elevated hCG level.
•Invasive mole responds well to chemotherapy but may
result in uterine rupture.

11. Choriocarcinoma
•It is a malignant neoplasm of trophoblastic cells derived
from a previous normal/abnormal pregnancy.
•50% - Complete hydatidiform mole
•25% - previous abortions
•22% - normal pregnancy
•Rapidly invasive and metastasize widely
•Non-gestational and gestational choriocarcinoma can be
differentiated by the absence of paternally derived DNA

12. Morphology
•Soft, fleshy, yellow-white tumour
•Large pale areas of necrosis and extensive hemorrage
•Histologically, consists of proliferating syncytiotrophoblast
and cytotrophoblast, chorionic villi is absent
•Mitoses abundant

13. Clinical features
•Irregular vaginal spotting of a bloody brown fluid.
•Discharge may appear in apparent normal pregnancy, after
miscarriage, after curettage.
•High propensity for hematogenous spread
•hCG levels elevated above hydatidiform mole
•Widespread metastases are characteristic
•Common sites are lungs, vagina, brain, liver, bone and
kidney
•Treatment – Evacuation of contents of uterus and
chemotherapy

14. Placental Site Trophoblastic Tumors
(PSTT)
•Neoplastic proliferations of extravillious trophoblasts –
intermediate trophoblast
•Normal extravillous trophoblasts are polygonal mononuclear cells
that have abundant cytoplasm and produce human placental
lactogen.
•Presents as a uterine mass, accompanied by either abnormal
uterine bleeding or amenorrhea and moderately elevated hCG.
•The malignant trophoblastic cells typically diffusely infiltrate the
endomyometrium.
•They may follow normal pregnancy, spontaneous abortion, or
hydatidiform mole.

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