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GESTIONAL TROPHOBLASTICNEOPLASIA

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Definition:o Abnormal placental (trophoblostic) proliferation

o Called molar pregnancy

Classification

Etiologyo Ethinic -Asian women living inAsia (up to 1 200)

- Low incidence in western European and U.S.A.

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oVery young women and the end of their years

oDietary folic acid deficiency

Hydatidiform mole (molar pregnancy)

o Complete hydatidiform mole

-Abnormal proliferation of the syncytiotrophoblost

- Replacement of normal placental by hydropic placentalvilli

- Not formation of feto

oPartial moles- Focal trophoblastic proliferation and degeneration of the

placenta

- Chromosomally abnormal fetus

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Genetic constitutions

oComplete mole

- Paternal origen blighted ovum by a haploid sperm- Karyotype 46 xx

- Is more common (90%) and malignant transformation is

>o Partial mole

- Triploidy most common 69 xxy

1 haploid set of maternal chromosome

2 haploid set of paternal chromosome

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Clinical Presentationo Uterine size/dates discrepancy

o Exaggerated subreactive symptoms of pregnancy

o Bleeding is the most characteristic (painless)

o Passage of edematous throphobost through the dilated cervical os

o Positive pregnancy test

o USG snowstorm

o Severe nausea and vomiting

o Pregnancy induced hypertension (pre eclampria)

o Proteinuria

o Hyperthyroidism

o Odnexal masses (theca lutein cyst)

o Histological

- Complete mole

- Invasive mole (chorioadenoma destruens) invading the

myometrium

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Clinical presentation parcial molar pregnancy

oSimilar to complete mole

o> gestional age (after 20th week)oUterine growth less than expected

oHypertension

oAbnormal fetus

Laboratory assessmant

o Level ofHCG classify risk

sensitive tumor marker (follow up)

oChest x ray

oHTO,HB, blood type

oProteinuria

oHyperthyroidism

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Treatment

oRemoval of the intrauterine contents

oDilatation of cervix, followed by suction curettageoGentle sharp curettage (small amount of myometrical tissue)

oLarge mole Atony uterine blood loss oxytocinblood

oPartial mole: > 24 week induction labor prostaglandinvaginal

-Associated trophoblostic emboli

- TTO pregnancy induce hypertension

oOlder reproductive age histerectomy (high risk)oBilaterally multicystic ovaries (theca Lutein cyst) do not

requere surgical removal.

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High Risk

Postevacuation management

oFollowed closely for at least 1 year

o

Sharp curettage determinin myometrial invasionoRhogam incomplete mole

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Metastatic/malignant gestional trophoblastic

neoplasia

oMalignant transformation hydatidiform molechoriocarcinoma

oMyometrial and uterine vassel invasion

oMetastasis hematogenous embolization

oLung, vagina, SNC, kidney, liveroMay also follow normal term pregnancy, abortion or ectopic

pregnancy

1 150.000 pregnancies

1 15.000 abortions1 5.000 ectopic

1 40 mola

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Non mestastatic persistentGNT single agent

chemotherapy

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