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DISEASES
G.T.D:
1-Hydatidiform Mole (V.M): Complete and partial
2-Invasive Mole
3-Placental site trophoplastic tumor
4-Gestational choriocarcinoma
PATHOLOGY
Loss of 23 23
23x 23
Maternal x 23x x
Genetic x
material
Loss of
Two paternal 23 23
23 Maternal
genetic x x
x Genetic
contribution
material
23 23
Duplication x x
of haploid
sperm
PARTIAL HYDATIDIFORM MOLE
23x
23x
23x
Choriocarcinoma:
-Choriocarcinoma is 1500 times more common after a molar
pregnancy than after a term delivery
-It is usually suspected after molar pregnancy if hCG failed
normalized after 6 months of evacuation.
-Choriocarcinoma and placental site tumor are the only G.T.T
originating from a term delivery or a non-molar pregnancy.
-Majority of choriocarcinoma present within a year of an
apparently normal pregnancy or non-molar abortion. However,
the presentation may be delayed for several years.
-Vaginal bleeding, bloodstained discharge, abdominal pain..
-Extra uterine and ovarian masses are frequent.
-In about 30%, the presenting features are non-gynecological:
pulmonary, cerebral, and hepatic (dyspnea,haemoptysis…..
Complications of GTD
-Hyperemesis gravidarum
-Thyrotoxicosis
-DIC
-AF EMBOLISM
-Local He
-Invasive Mole: perforation
-Choriocarcinoma:2-5%
-complication of cyst (TRH)
INVESTIGATION:
-: measurement of hCG
* every 2 weeks till limit of detection
then *monthly during first year
then *3-monthly during second year
and after all further pregnancy (bec. Risk of recurrence and risk
of choriocarcinoma arising even following normal pregnancy)
-Further pregnancy should not be attempted till hCG is normal for at
least 6 months
Indications for chemotherapy of G.T.T:
hCG monitoring:
-Rising hCG after evacuation
-hCG is not falling (plateau) 4 months after evacuation
-hCG > 20,000 mIU/L
Metastases:
-pulmonary, vulval or vaginal metastasis
-Any other metastases
Presentation:
-Heavy vaginal bleeding or intraperitoneal bleeding
Histopathological diagnosis of choriocarcinoma
Prognostic Factors:
Prognostic factor 0 1 2 4