OBGYNE 32 05 March 2019

GESTATIONAL TROPHOBLASTIC DISEASES Natakneng 2020

Ruth Judtih Cristobal, MD, FPODS, FSGOP, FPCP, MHCA Mariano Marcos State University
2. Reproductive and Obstetric History
Outline:  No association in parity
A. Gestational Trophoblastic Diseases  2-fold increase in >5 pregnancies
a. Hydatidiform Mole  20-24x relative risk of recurrence
i. Complete  SS0.6-2.60% of pregnancies – risk of 2nd
ii. Partial
molar
b. Invasive hydatidiform  Increase after twin birth
c. Choriocarcinoma  Increase after artificial insemination by donor
d. Placental Site Trophoblastic Tumor 3. Ethnicity
e. Trophoblastic Lesions  8.0 per 1000 pregnancies in Caucasians
f. Unclassified Trophoblastic Lesions  17.5 in Filipinos
i. Exagerrated placental site
 16.5 in Japanese
ii. Placental site nodule or
plaque  7.7 in Hawaiians
B. Gestational Trophoblastic Neoplasia 4. Family Occurrence
 Only a very few reports to describe familial
GESTATIONAL TROPHOBLASTIC DISEASE occurrence
 A group of diseases characterized by an abnormal  Report of cases of molar pregnancy among
proliferation of the trophoblasts of the placenta. relatives of patients with molar pregnancy in
 Encompasses the histopathological entities of: Italy
o benign complete and partial mole  Recurrent molar pregnancies among sisters in
o invasive mole 3 families in India
o choriocarcinoma 5. Diet and Nutrition
o placental site trophoblastic tumor  2-7x risk in mild to severe malnutrition
o trophoblastic lesions  Decrease risk with increase intake of carotene
GESTATIONAL TROPHOBLASTIC NEOPLASIA and fats
 A condition if there is any evidence or persistence of 6. Environmental Factors
GTD, most commonly defined as a persistent elevation  Cigarette smoking
of β-HCG  Oral contraception and IUD use
 Epidemiology:
o Incidence rate: PATHOLOGY OF GTD
 1:1000 pregnancies in US  Early embryonic differentiation
 0.81-1 China  Trophoblasts – derived from the outer blastocyst layer
 0.6-1.1 in Europe and North America  3 distinct trophoblasts recognized:
 up to 2 in Japan o Cytotrophoblasts – trophoblastic stem cells
 2.2-5.0 in Africa* that differentiate along a villous and
 13 in Indonesia* extravillous pathway
 increase prevalence in third world o Syncytiotrophoblasts – production of
countries pregnancy-associated β-HCG and human
 In the PH placental lactogen (HPL)
- 2.4 H. mole in 1000 pregnancies o Intermediate trophoblasts
- 0.56 GTN in 1000 pregnancies
(2002-2008)
RISK FACTORS
 Multiple factors considered
 Etiology and factors – poorly understood
1. Age Factors
a. Maternal Age
J-curve incidence report
Increased risk in 15-20 years old
20-fold higher in under age 15
200x higher in >50 years old
Suggests defect in ovoid function
b. Paternal Age – inconsistent
*Villous trophoblast
 forms the interface between maternal and fetal tissues

DJD Comprehensive Gynecology, Doc 1 of 2

OBGYNE 32: GYNECOLOGIC TROPHOBLASTIC DISEASES

 composed of cytotrophoblasts and syncytiotrophoblasts

 responsible for molecular exchange across
compartments PARTIAL MOLE
 2 types
*Extravillous pathway  Hydrophic
 Differentiate into intermediate trophoblasts in the  Normal in size
placental bed at the implantation site.  Less voluminous
 Responsible for establishing maternal-fetal  Presence of embryo or fetus
circulation and infiltrating the decidua and  DISPERMY PLUS MATERNAL CHROMOSOME
myometrium.

WHO Histopathologic Classification of GTD

1. Hydatidiform Mole
a. Complete
b. Partial
2. Invasive hydatidiform
3. Choriocarcinoma
4. Placental Site Trophoblastic Tumor
5. Trophoblastic lesions
6. Unclassified trophoblastic lesions
a. Exaggerated placental site
b. Placental site nodule or plaque

HYDATIDIFORM MOLE
Complete Mole
 Grape-like
 Transluscent vesicles
 1-2 cm in diameter
 Voluminous in curettage
 Markedly enlarged uterus
 Absence of embryo or fetus
 PATERNAL CHROMOSOME ONLY

DJD Comprehensive Gynecology, Doc 2 of 2