Transcript Fine Needle Aspiration Biopsy of the Liver

GESTATIONAL TROPHBLASTIC
DISEASE
Divided into three categories:
Hydatidiform Mole
Invasive Mole
Choriocarcinoma
All elaborate high titer of human chorionic
gonadotropin(hCG) in the blood and urine.
The titer progressively increase from hydatidiform
mole to invasive mole to choriocarcinoma.
The change in (hCG) level, fall or rise, aid in the
monitoring the effectiveness of the treatment.
HYDATIDIFORM MOLE
COMPLETE AND PARTIAL
Incidence
1-1.5/ 2000 pregnancies in the united
states and western countries.
Higher incidence in Far East countries (
10in1000 in indonesia).
Occur before 20y and after 40y.
Is common complication of gestation.
GESTATIONAL TROPHOBLASTIC
DISEASE:
HYDATIDIFORM MOLE, COMPLETE
TYPE
Swollen, avascular
villi covered by
chorionic epithelium
(trophoblast) of
varying atypia
Gross appearance is
that of a voluminous
mass of grape like
structures
Partial hydatidiform
mole
Is developed as the result of
fertilization of a normal egg by two
spermatozoa.
The chorionic epithelial cells are always
triploid (69XXY).
Serum HCG level is less elevated.
Rarely progresses to choriocarcinoma.
GESTATIONAL TROPHOBLASTIC DISEASE:
COMPLETE VERSUS PARTIAL HYDATIDIFORM MOLE
FEATURE
Karyotype
COMPLETE
46, XX (rare XY)
PARTIAL
69, XXY
Villous edema
all villi
some villi
Trophoblast Proliferation
Atypia
diffuse; circumferential
often
partial
serum HCG
elevated
less elevated
HCG in tissue
++++
+
Behavior
2% get chorio-
rare chorio-
carcinoma
absent
carcinoma
INVASIVE MOLE
It is intermediate
between a benign mole
and choriocarcinoma.
It is invasive locally but
have no metastatic
potential.
Invasive mole have
edematous villi
penetrating the uterine
wall deeply causing
severe hemorrhage.
CHORIOCARCINOMA
e from
It is an aggressive malignant tumor , aris
the gestational chorionic epithelium or from
totipotential cells within the gonads or elsewhere.
Incidence is 1/30000 pregnancies in the west and
USA, more common in Asian and African 1/2000
pregnancies.
Occur at age 20y and after 40y.
50% of choriocarcinoma follow a complete mole
25% arise after abortion
20% occur after normal pregnancy
CHORIOCARCINOMa
CHORIOCARCINOMA
Treatment:
Chemotherapy
Maternal immune response against the
foreign paternal antigen aids in the
effectiveness of treatment.