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Neoplasia
WALEED AL-JASSAR
FRCSC – GYN ONC
Classification
• Hydatidiform Mole ( Molar
Pregnancy )
• Invasive Mole
• Gestational Choriocarcinoma
• Placental Site TrophoblasticTumor
( PSTT )
•
•
History
• Hippocrates
– Dropsy of the uterus
• Unhealthy water
Epidemiology of Hydatidiform
Mole
• The highest incidence is in Asia
• Rates in Asia 1 : 500
• Rates in the states 1 : 1500
Risk Factors for Molar
Pregnancy
• Extremes of Reproductive age
– Less than 15 years old and above age
40
• History of previous Molar pregnancy
– 10 times more risk
• Dietary factors
– Low protein diet
Factors NOT associated with
Molar Pregnancy
•
• ABO Blood Group
•
• Cigarette smoking
•
• Contraceptive history
Hydatidiform Mole
• Complete Mole
• Partial Mole
Complete Mole
• 46 XY ( Paternal Genome )
• Absent fetus
• Absent Amnion
• Diffuse Villous edema
• Diffuse trophoblastic proliferation
• Uterine size is 50% large for dates
• 25-30% Theca Leutein Cysts
• 10-25% Medical Complications
– PIH , Hyperthyroidism , Anemia and
Hyperemesis
• 6.8 – 20% Post Molar GTN
Partial Mole
• 69 XXX or XXY ( Paternal and Maternal
Genome )
• On Pathology Fetal Parts are present
• Focal Villous edema
• Focal Trophoblastic proliferation
• Diagnosed as Missed Abortion
• Uterus is small for dates
• Rarely there will be a Theca Lutein Cyst
or medical Complication
• 2.5 – 7.5 % Postmolar GTN
Symptoms
• Vaginal Bleeding
• Hyperemesis
• Pre-eclampsia in the first Trimester
• Hyperthyroidism ( rarely )
• Acute Respiratory Distress
– Trophoblastic pulmonary embolization
• Excessive uterine size
• Theca lutein cyst
diagnosis
• Passage of Vesicular tissue
• Quantitative B hCG
• Pelvic U/S
•
Management
• Blood Work ( CBC , Electrolytes , LFT ,
RFT , TFT )
• CXR ( Pre Evacuation )
• Suction D & C
• Monitor Quatitative hCG every week
until Normal
• Monthly hCGfor 6 – 12 months
• Contraception
Gestational Trophoblastic
Neoplasia
• Defined by Clinical and Laboratory
Criteria