Gestational Trophoblastic

Neoplasm:

Invasive Mole
&
Choriocarcinoma
By: Parmitasari

Invasive Mole

Biologically, invasive mole is the intermediate form

of hydatidiform mole (complete and partial) and
choriocarcinoma

Locally destructive but very unlikely to metastasize

10% of complete moles develop into invasive mole
Overall, invasive moles occur at an estimated rate
of 1 pregnancy in 15,000.

Invasive mole

Defined as mole that penetrates and may

even perforate the uterine wall

Macroscopically:
presents as hydropic chorionic villi that
invade myometrium uterine rupture

Figure 22-66 A, Invasive mole presenting as a hemorrhagic mass

adherent to the uterine wall. (Courtesy of Dr. David R. Genest,
Brigham and Women's Hospital, Boston, MA.)
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 12 February 2007 02:26 AM)
2007 Elsevier

Invasive mole

Microscopically:
Proliferation of both cytotrophoblast and
syncytiotrophoblast
May invade parametrial tissue and blood
vessels

Invasive mole

Clinical manifestation:
Vaginal bleeding
Irregular uterine enlargement
Persistent elevated -HCG
Metastases
No distant metastases
Hydropic villi may embolize to distant sites
( e.g lungs, brains) do not grow as true
metastases

Invasive mole

Prognosis
The tumor responds well to
chemotherapy
May result in uterine rupture need
hysterectomy

Choriocarcinoma
Gestational choriocarcinoma is an epithelial
malignant neoplasm of trophoblastic cells
derived from any form of previously normal or
abnormal pregnancy

Rapidly invasive, widely metastasizing

malignant neoplasm

choriocarcinoma

Incidence
choriocarcinoma is an uncommon condition:
U.S. 1:20,000-1:30,000
Ibadan, Nigeria & Asian coutries 1:2500

Etiology
50% arise in hydatidiform moles
25% in previous abortions
22% in normal pregnancies

choriocarcinoma

choriocarcinoma
1:40 hydatidiform moles
1:150,000 normal pregnancies

Macroscopically

soft, fleshy, yellow-white tumor

Large pale areas of ischemic necrosis, foci of
cystic softening, and extensive hemorrhage

Figure 22-67 A, Choriocarcinoma presenting as a bulky hemorrhagic mass invading

the uterine wall. (Courtesy of Dr. David R. Genest, Brigham and Women's Hospital,
Boston, MA.)
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 13 February 2007 03:20 AM)
2007 Elsevier

choriocarcinoma

Microscopically
Purely ephitelial tumor
Does not produce chorionic villi
Abnormal proliferation of both
cytotrophoblast and
syncytiotrophoblast

Choriocarcinoma, characterized by proliferation of cytotophoblast (blue

circle) and syncytiontrophoblast (green circle), but no villi are present.

Figure 21-27 Choriocarcinoma shows clear cytotrophoblastic cells with central nuclei
and syncytiotrophoblastic cells with multiple dark nuclei embedded in eosinophilic
cytoplasm. Hemorrhage and necrosis are prominent.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 13 February 2007 03:20 AM)
2007 Elsevier

choriocarcinoma

Clinical course

Manifest by irregular spotting of a bloody, brown,

sometimes foul-smelling fluid
Usually, by the time the tumor is discovered
locally, radiographs of the chest and bones already
disclose the presence of metastatic lesions
The titers of -HCG elevated > in hydatidiform
moles
The tumor invades myometrium uterine serosa,
penetrates blood vessels and lymphatics

Metastases
Widespread metastases
characteristic!!
Lungs (50%), vagina (30-40%), brain,
liver and kidney

choriocarcinoma

Prognosis
Respond well to chemotherapy
Up to 100 % cure or remission

Invasive Mole
Chorionic villi (+)
Locally destructive, no
metastases
Proliferation of
cytotrophoblast and
syncytiotrophoblast
Respond well to
chemotherapy

Choriocarcinoma

Chorionic villi (-)

Widespread metastases
Proliferation of
cytotrophoblast and
syncytiotrophoblast
Respond well to
chemotherapy

Reference:
Robbins and Cotran Pathologic Basis of
Disease. 7th Edition. (V Kumar, A K
Abbas, and N Fausto). Philadelphia.
Elsevier Saunders.