Dr. Madhavi Karki

DEFINITION : GTD refers to the spectrum of proliferative abnormalities 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 expulsion Group B: The uterus is still inert

Supportive therapy: Group A Morphine 15mg IM is given 5% dextrose drip started Arrangement is made for blood transfusion Group B Blood should be kept prior to elective termination Definitive Therapy : Group A and Group B: Suction and evacuation

Indications of Chemotherapy :

Follow – up Protocols :