Dr. Madhavi Karki

DEFINITION : GTD refers to the spectrum of proliferativeabnormalities of the trophoblast associated with pregnancy.

CLASSIFICATION

Hydatiform Mole (Syn : Vesicular Mole)

ETILOGY

Partial Mole Complete Mole Feature

Triploid 46 XY Karyotype

Present Absent Embryo

Scalloped, less swollen, focal villi involved with fibrosis

Round, swollen, all villi involved

Villi

Focal, minimal Circumferential, marked

Trophoblastic proliferation

None Often present Trophoblastic atypia

PLAP, rare hCG hCG, rare PLAP* Immunocytochemistry

Often small for dates

Often large for dates

Uterine size

Rare Present in 25 percent

Theca lutein cysts

Occur in less than 5 percent

Occur in up to one-third

Malignant sequelae

Pathology

Fig : H. Mole showing clusters of vesicles of varying sizes

Symptoms :

SIGNS :

INVESTIGATIONS

Fig: H. Mole

Complications

To give adequate supportive therapy to restore blood loss

To evacuate the uterus as soon as the diagnosis is made

- Risk of hemorrhage- Perforation of the uterine wall by the mole To take appropriate steps to minimize

infection.The patients are divided into two groups:Group A: mole is in the process of expulsionGroup B: The uterus is still inert

Supportive therapy: Group Ai) Morphine 15mg IM is givenii)5% dextrose drip startediii)Arrangement is made for blood

transfusionGroup B i) Blood should be kept prior to elective

termination

Definitive Therapy : Group A and Group B:Suction and evacuation

Indications of Chemotherapy :

Follow – up Protocols :