GESTATIONAL TROPHOBLASTIC DISEASE- 1

GTN (gestational trophoblastic neoplasia)

It is a spectrum of diseases arises from aberrant fertilization event (fetal tissues within maternal host) that includes:

1- Benign hydatidiform mole which further subdivided into partial and complete mole.
2- Invasive mole (chorioadenoma destruens) which can metastasize.
3- Choriocarcinoma (frankly malignant).
4- Placental site trophoblastic tumour (PSTT).
The majority of the patients follow a benign course 80-90% and their disease remitting spontaneously.
The disease is characterized by the sensitive tumour marker (?-hCG) which is secreted by the tumour cells and allows accurate follow up of the disease.
So any woman with molar pregnancy, normal pregnancy or abortion who is presented with bleeding or a tumour should have at least one (?-hCG) assay. To exclude GTN.
Pathology:

Molar pregnancy is abnormal pregnancy characterized by multiple grapelike vesicles filling and distending the uterine cavity sometimes it develop in the tubes or the ovary, the fetus is abscent in complete mole.
While the partial mole the fetus is present and died in the 8-9 weeks
Invasive mole:
It occur in 20% of patients with H.mole, pathologically it is the same as hydatidiform mole but penetrates deeply into the myometrium or the adjacent structures leading to uterine rupture and haemoperitoneum. It may regress spontaneously.
Choriocarcinoma:
It is purely epithelial tumour composed of syncytiotrophoblast and cytotrophoblast; it may accompany or follow any type of pregnancy, 50%after H. Mole, 25% after normal pregnancy and 25% after abortion.
Diagnosis of Molar pregnancy:
depend on clinical features and investigations
and the most important is the need for high clinical suspecion
the treatment depend on the presentation and the presence of risk factors of persistant disease:
the gold standard is by dilatation and suction curettage