Obstetrics: Hydatidiform Mole and Choriocarcinoma

Hydatidiform Mole

• Also known as molar pregnancy.
• Characterized by the abnormal proliferation of trophoblastic cells.
• Two types: complete mole (46XX or 46XY) and partial mole (69XXX, 69XXY, or 69XYY).
• Presents with vaginal bleeding, enlarged uterus for gestational age, and elevated hCG levels.
• Diagnosis with ultrasound showing a "snowstorm" or "cluster of grapes" appearance.
• Treatment involves dilation and curettage (D&C) and monitoring hCG levels.

Choriocarcinoma

• A malignant trophoblastic tumor.
• Can arise from a complete mole, partial mole, ectopic pregnancy, or even normal pregnancy.
• Presents with symptoms like irregular vaginal bleeding, pelvic pain, and respiratory distress.
• Diagnosis through elevated hCG levels and imaging studies.
• Treatment includes chemotherapy with drugs like methotrexate, etoposide, and cisplatin.

Epithelioid Trophoblastic Tumor

• A rare and aggressive form of gestational trophoblastic disease.
• Composed of epithelioid trophoblastic cells.
• Presents with abnormal vaginal bleeding and an enlarged uterus.
• Diagnosis with histopathology showing epithelioid cells with abundant eosinophilic cytoplasm.
• Treatment involves surgery and chemotherapy.

Placental Site Trophoblastic Tumor

• Rare, indolent form of gestational trophoblastic disease.
• Arises from the implantation site of a previous pregnancy.
• Presents with irregular vaginal bleeding.
• Diagnosis with histopathology showing intermediate trophoblastic cells at the implantation site.
• Treatment includes surgical resection and sometimes chemotherapy.

Molar Pregnancy Complications

• Potential complications of molar pregnancies include:
  • Persistent gestational trophoblastic disease (PTD) requiring chemotherapy.
  • Risk of developing choriocarcinoma.
  • Recurrent molar pregnancies in subsequent pregnancies.
  • Increased risk of thyroid dysfunction.
  • Risk of uterine perforation during D&C procedure.
• Close monitoring of hCG levels post-molar pregnancy is crucial to detect and manage complications promptly.

Hydatidiform Mole

• Characterized by abnormal proliferation of trophoblastic cells
• Two types: complete mole (46XX or 46XY) and partial mole (69XXX, 69XXY, or 69XYY)
• Presents with vaginal bleeding, enlarged uterus for gestational age, and elevated hCG levels
• Ultrasound diagnosis shows a "snowstorm" or "cluster of grapes" appearance
• Treatment involves dilation and curettage (D&C) and monitoring hCG levels

Choriocarcinoma

• A malignant trophoblastic tumor arising from molar pregnancy, ectopic pregnancy, or normal pregnancy
• Presents with irregular vaginal bleeding, pelvic pain, and respiratory distress
• Diagnosis through elevated hCG levels and imaging studies
• Treatment includes chemotherapy with methotrexate, etoposide, and cisplatin

Epithelioid Trophoblastic Tumor

• A rare and aggressive form of gestational trophoblastic disease
• Composed of epithelioid trophoblastic cells with abundant eosinophilic cytoplasm
• Presents with abnormal vaginal bleeding and an enlarged uterus
• Diagnosis with histopathology showing epithelioid cells
• Treatment involves surgery and chemotherapy

Placental Site Trophoblastic Tumor

• A rare, indolent form of gestational trophoblastic disease arising from the implantation site of a previous pregnancy
• Presents with irregular vaginal bleeding
• Diagnosis with histopathology showing intermediate trophoblastic cells at the implantation site
• Treatment includes surgical resection and sometimes chemotherapy

Molar Pregnancy Complications

• Persistent gestational trophoblastic disease (PTD) requiring chemotherapy
• Risk of developing choriocarcinoma
• Recurrent molar pregnancies in subsequent pregnancies
• Increased risk of thyroid dysfunction
• Risk of uterine perforation during D&C procedure
• Close monitoring of hCG levels post-molar pregnancy is crucial to detect and manage complications promptly