TRATTAMENTO

1
Clinical aspects of Gestational Trophoblastic
Disease
Giorgia Mangili Dipartimento Materno
Infantile UF Ginecologia Oncologia IRCCS San
Raffaele mangili.giorgia_at_hsr.it
2
Diagnosis

• Clinical
• Ultrasound
• Histopathology

3
Clinical presentation classical presenting
symptoms

• Vaginal bleeding
• Anaemia
• Uterine size greater than dates
• Theca-lutein ovarian cysts
• Hyperemesis

4
Clinical presentation Complication medically
important but infrequent

• Pre-eclampsia
• Hyperthyroidism
• Respiratory insufficiency
• Cardiopulmonary complications
• Uterine perforation

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Hydatidiform Mole

• 1960-1970 HM generally diagnosed in the second
  trimester
• Clinical features often referred to second
  trimester symptoms

but Clinical presentation of HM has changed
considerably over the past decades
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Clinical presentation and historic case at the
New England Trophoblastic Disease Center
Soto-Wright obstet.gynecol 1995
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Weeks of gestation at evacuation
Soto-Wright Obstet-Gynecol 1995
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And in Italy? In Lombardia?
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Clinical presentation of HM
Mangili Am J Obstet Gyn 2008
10

• Hydatidiform mole is often asymptomatic
• Signs and symptoms are those of incomplete
  abortion or missed abortion

But Be Careful !
Immigrants
Father of the Bride Part II
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Clinical presentation in elderly patients
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Hydatidiform mole

• HM classifica tion
• Gross morphology and hystopatology
• Clinical features
• Risk of developed GTT
• Karyotype

complete
partial
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Difference in molar pregnancy
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Molar Features
Caratteristiche
Mola completa
Mola parziale
Aborto idropico
VECM






Dimensioni dei villi



Contorno villi


Idrope


Cisterne

Vasi

Globuli rossi fetali

Pseudoinclusioni

Iperplasia trofoblastica



Trofoblasti extravillari

Sito dimpianto


Parti Fetali

Stroma


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Should we change the definition of complete and
partial mole?

• Is the definition of diploid and triploid
  Hydatidiform mole more correct ?

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• Most CM are diagnosed and evacuated as abnormal
  pregnancy in the first trimester
• Morphologic and genetic studies suggest that CM
  are not strictly anembryonic
• CM may show only mild or partial hydrops
• The features of young CM and their partial
  hydrops often lead mistaken diagnosis of PM
• Are incidences of persistent disease after
  spontaneous abortion due to a early complete
  mole?

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Risk of GTT

• 162 diploid mole
• 105 triploid
• 17.3 diploid GTT
• 0 triploid GTT

Niemann Obstet Gynecol 2006 1071006-11

• The risk of GTT after triploid mole is low (from
  0 to 0.001)

7.5
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Conclusion

• There has been a marked change in the way
  moles present clinically, radiological and
  pathologically mainly due to the introduction of
  ultrasound in the diagnosis and management of
  abnormal pregnancy

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Conclusion

• Diagnosis of hydatidiform mole is often difficult
• Almost all patients with molar pregnancy are
  diagnosed and treated before they develop classic
  presentation
• Scanty material
• Early complete mole
• Ploidy analysis can be useful
• A correct diagnosis of HM is possible but can be
  expensive in terms of pathologists time and
  additional investigation
• Less strict protocols for the follow up can be
  considered
• Attention for histological misdiagnosis

20
Clinical presentation in elderly patients
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Classical presenting symptoms

• 58 vaginal bleeding
• 2 Anaemia
• 44 uterine size greater than dates
• 2 hyperemesis
• Mean gestational age at evacuation 10 weeks

Gemer et al. 2000
Gemer et al. 2000