Gestational trophoblastic disease

Gestational trophoblastic disease is a fetal invasion of tissues that defies normal control mechanisms. Normally, trophoblast invasion should resolve within 30 days of termination of pregnancy (delivery, miscarriage, ectopic pregnancy). We distinguish mola hydatidosa partialis, mola hydatidosa completa, mola hydatidosa proliferans a choriokarcinom.

Partial (incomplete) hydatidiform mole
Mola hydatidosa partialis (MHP) it is created by the fertilization of an egg by two sperm at the same time (69,XXX; 69,XXY).The resulting triploid zygote has two sets of paternal and one set of maternal haploid chromosomes. It rarely becomes malignant. Clinically, there is irregular bleeding in the first trimester (due to developmental defects, the fetus rarely survives delivery, if it survives, it always dies after it). The treatment is vacuum exhaust and RCUI, dispensary and monitoring of hCG levels.

Complete hydatidiform mole
Mola hydatidosa completa (MHC) it is created by fertilization of an empty egg (0 chromosomes) by two sperm at the same time (46,XX; 46,XY),or by a single sperm that endoreduplicates (46,XX). Both sets of chromosomes are thus of paternal origin. The embryo cannot develop, the villi are avascular, edematous, with the appearance of "wine grapes“ . The image of "snowfall" is visible on the ultrasound . Malignant in 4-8 % . The treatment is vacuum exhaust and RCUI, dispensary and monitoring of hCG levels.

Proliferating mole
Mola invasiva (mola proliferans, mola destruens, MP) is the most aggressive. Biologically, it is of an uncertain nature. Treatment is vacuum exhaust and RCUI, 20% require chemotherapy.

Choriocarcinoma
Choriokarcinoma is an epithelial tumor of trophoblast cells. It metastasizes early hematogenously to the vagina, lungs, liver and brain.

It is the most treatable malignant tumor, it is treated with methotrexate or actinomycin D in mono- or polychemotherapy with curative intent in all stages with a good prognosis. The treatment is carried out in a specialized center.

Related articles

 * Malignant tumors in gynecology
 * Germinal tumors
 * Malignant tumors of the ovaries