2. Key Words
n Group of disease with wide range of
neoplastic potential
n Create a lot of challenge for us in term of
diagnosis and treatment
n Diagnosis and management will depends
on the history, HCG level and metastasis
work up
3. Clinical pathology of gestational trophoblastic disease
n 1- Cytotrophoblast and syncytiotrophoblast
cells proliferation
Moler pregnancy
Invasive mole
Choriocarcinoma
n 2- Intermediate trophoblastic cells
derivative
Placental – site tumor
4. Risk Factors for Moler pregnancy
n Extremes of reproductive years
n Prior moler mole
n Prior spontaneous abortion
n Vit A deficiency
n Race ( Indonesia 1:85, USA 1:1500)
12. Clinical Features
n Large for date 50 %
n Hyper emesis 20 %
n Early PIH 5%
n Abscent FH ( except in partial mole or
twin pregnancy)
n Hyperthyroidism symptom and sign 5%
n Rarely presented with metastasis symptom
and sign
15. Follow up of patient with molar
pregnancy after evacuation
n HCG weekly serum determination until
normal for two values ,then monthly for
6 to 12 months
n Contraception for 1 year
n Pelvic examination every 2 weeks until
normal,then every 3 months
n Check histopathology
20. Indication for initiating treatment
during post mole follow up
n Serum BHCG values rising more than 10 % for 2
wk ( 3 weekly titre)
n Serum BHCG values on plateau for 3 wk or
decline of less than 10 %
n Presence of metastasis
n Significant elevation of serum BHCG values after
reaching normal levels
n Choriocarcinoma or invasive mole on
histopathology
n HCG level still elevated 6 months after molar
evacuation
n HCG > 20000 miu/ml 4 weeks after evacuation
21. Work up of gestational
trophoblastic neoplasia
n History and physical examination
n chest XR ( if neg è CT )
n Pretreatment HCG titre
n Hematological survey
n Serum chemistries
n CT of brain
n Ultrasound of pelvis
n Liver scan ( u/s or CT )
22.
23.
24.
25.
26.
27. CLASSIFICATION OF GESTATIONAL
TROPHOBLASTIC DIS
n Benign
1) complete mole
2) Partial mole
n Malignant (invasive mole and
choriocarcinoma)
1) nonmetastatic
2) metastatic
a) low risk b) high risk
28. Risk factors
(malignant GTD)
1.Disease present more that 4m(long
duration) or
2.pretreatment B-HCG greater than
40,000mlu/ml or
3.presence of met to sites other than
lungs or vagina i,e liver or brain etc..
4. prior chemo
5 following Term pregnancy
29. CHEMOTHERAPY FOR GTN
NON METASTATIC
or
GOOD PROGNOSIS
METASTATIC
*Single agent
chemotherapy
*survival 90-100%
METASTATIC POOR
PROGNOSIS
*Combined
chemotherapy
* survival 50 %
30. REMISSION OF GTN
DISEASE REMISSION
NON METASTATIC 100 %
GOOD PROGNOSIS METASTATIC 100 %
POOR PROGNOSIS METASTATIC 66 %
TOTAL 92 %
31. SUMMARY
GTD IS A RARE ENTITY THAT IS HIGHLY
CURABLE , EVEN IN THE PRESENCE OF
WIDESPREAD METASTASES
