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Gestational Trophoblastic Disease


What is Gestational Trophoblastic Disease?

 Gestational trophoblastic disease(GTD) is the term used to encompass a group of tumors typified of abnormal trophoblast proliferation.

 GTD histologically is divided into Hydatidiform moles, which are characterized by the presence of villi, and non-molar trophoblastic neoplasm, which lacks villi.

 Types of GTD

 The main types of gestational trophoblastic disease are:

  • Hydatidiform  moles: complete and incomplete(partial)
  • Non-trophoblastic neoplasms: which include choriocarcinoma, placental site trophoblastic tumor, epithelioid trophoblastic tumor.
  • Gestational Trophoblastic Neoplasia: which includes invasive mole and the above three.

Hydatidiform Mole - Molar Pregnancy

It is the most common type of gestational trophoblastic disease. The classic histological findings of a molar pregnancy include villous stromal edema and trophoblast proliferation. 

Molar pregnancy arises from chromosomally abnormal fertilization. Molar pregnancy is usually benign but sometimes turns into a malignant form.

There are two types of Molar pregnancy: complete and partial mole pregnancy.

Complete Mole: It has abnormal chorionic villi that grossly appear as a mass of clear vesicles. Most often they are diploid chromosomal composition. Meaning 46,XX, and result from androgenesis. 

 Incomplete(partial)Mole: Pregnancy has focal and less hydatidiform changes and contains fetal tissue. Partial moles have triploid karyotype----> 69,XXX, 69,XXY, or rarely 69,XYY.

 Gestational Trophoblastic Neoplasia

 There are several types of gestational trophoblastic neoplasia:

 Invasive Mole: The most common type of gestational trophoblastic neoplasia. They follow hydatidiform moles. Characterized by extensive tissue invasion by trophoblast and whole villi. Although highly invasive locally they are less likely to metastasize to other parts of our body.

 Gestational Choriocarcinoma: Mostly follow term pregnancy or a miscarriage. It contains no villi, but rather have early reminiscent of cytotrophoblast and syncytiotrophoblast. It has a tendency to metastasize. The most common sites being lungs and vagina. Most accompanied by Theca-lutein cysts.

 Placental-Site Trophoblastic Tumor: This is an uncommon type of tumor. It arises from the implantation site intermediate trophoblast. It is highly invasive locally and is resistant to chemotherapy.

 Epithelioid Trophoblastic Tumor: This tumor is a rare tumor arising from chorionic type trophoblast. About 50% of women have metastasis. Hysterectomy is the best treatment option for non-spread disease.

 Gestational Trophoblastic Disease Risk Factors And Causes

 Here some risk factors contributing to this condition

  • Age: Women at both extremes of reproductive age are most at risk.
  • Previous History: For those with a prior history of GTD is 2%
  • History of Abortion
Symptoms of Gestational Trophoblastic Disease

These are the most common presenting symptoms of gestational trophoblastic disease
  • Amenorrhea
  • Vaginal Bleeding 
  • Anemia 
  • Hyperemesis(excessive vomiting)
  • Preeclampsia symptoms
  • Pain around the pelvis
  • Suddenly enlarged uterus
Diagnosis Of Gestational Trophoblastic Disease

After doing a physical examination and taking a history, some of this test might be ordered

  • Pelvic examination
  • Serum beta-HCG measurements
  • Ultrasound
  • Pap Smear
  • Blood tests
  • Urine analysis
For suspected malignant cases we might also do these diagnostic measures
  • Chest X-ray
  • Spinal Tap
  • CT scan of the abdomen
Treatment Of Gestational Trophoblastic Disease

Treatment methods include:
  • Hysterectomy
  • Radiation therapy
  • Chemotherapy
  • Surgery
The treatment options depend on the severity, type, and extent of the disease. And also on whether you wish to have kids after or not.

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