Disease of the trophoblast and Breast

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Disease of the trophoblast and Breast

• Dr. Amitabha Basu MD

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Our lecture topic

1. Hydatidiform mole Gestational trophoblastic
   disease
2. Choriocarcinoma
3. Breast

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Hydatidiform mole

1. Definition
2. Types
3. Pathogenesis
4. Complete Vs partial Mole
5. Morphology
6. Clinical features

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Definition

• A voluminous, cystically dilated chorionic Villi
  appearing grossly as grape like structure.

But these grapes are sour !!!!!!
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Types

• Complete Mole
• Partial Mole
• INCIDENCE 1-1.5 PER 2000 PREGNENCY IN USA.

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Etiopathogenesis

• Asian countries.
• Mother over 40 or under age 20.

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Pathogenesis complete mole
This mole has only paternal chromosome thus
this mole DOES NOT contain Fetal parts
Androgenetic mole.
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Pathogenesis complete mole
This mole has BOTH paternal and maternal
chromosome thus this mole contain Fetal parts (
Tissue).
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Complete Vs Partial Mole
Features Complete Partial Mole
Villous edema All Villi Some Villi
Karyotype 46, XX(46XY) Triploid ( 69XXY)
Trophoblastic proliferation Diffuse Focal ,slight
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Features Complete Mole
Partial Mole
Atypia Often Present Absent
Serum hCG Elevated Less elevated
hCG
Behabiour 2 choriocarcinoma Rare
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Features Complete Mole
Partial Mole
Morphology Micro All Villi are a-vascular and show stromal edema. Some normal Villi are present.
Fetal parts Absent Present
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FREQUENT SIGNS AND SYMPTOMS

• Uterus too large for dates
• Vaginal bleeding.
• Morning sickness that is frequently excessive.
• Passage of vesicle (small sac).

Discovered By 12 to 14 week.
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Morphology Complete mole Gross
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The villi are avascular and show extensive
stromal edema.
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Partial Villi scattered hydropic swollen villi
are present.
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Diagnosis

• Ultrasound examination
• Physical examination Uterus size larger for
  Dates.
• Increased beta HCG.

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Snow Storm appearance No fetus.
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Choriocarcinoma

• Very aggressive malignant tumor.
• Cell of origin
• Trophoblastic cells of placenta (gestational).
• Totipotent cells (ovary , testis).

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Incidence

• Age Before 20, after 40.
• High Risk
• 50 Follow complete mole
• 25 After abortion
• Remainder after pregnancy.

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Choriocarcinoma General Features

• Site of Metastasis
• LUNG ,VAGINA, BRAIN, LIVER, KIDNEY.
• Route of metastasis Hematgenous

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Gross Large , hemorrhagic , infiltrative mass
in uterus
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Micro a hemorrhagic tumor composed of anaplastic
cuboidal cytotrophoblast and syntiotrophoblast.
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Micro a hemorrhagic tumor composed of anaplastic
cuboidal cytotrophoblast and syntiotrophoblast.
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Diagnosis and Management

• RAISING TITRE OF betahcG

Gestational choriocarcinoma respond very well in
chemotherapy. ! but not that arise in ovary
/testis.
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Preeclamsia / eclamsia of pregnancy
Preeclamsia Hypertension, edema and protenuria ( in the third term of pregnancy).
Eclamsia Hypertension, edema and protenuria convulsive seizures. Complication DIC
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Placental pathology in Preeclamsia / eclamsia

1. Infarction
2. Fibrinoid necrosis of the placental vessel wall.

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Thank you !

• Best of luck

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Thank you

• Next topic in Breast carcinoma file.